Extent of physician–pharmaceutical industry interactions in low- and middle-income countries: a systematic review
Open accessAbstract
Background: Pharmaceutical companies spend large amounts of money promoting their products to physicians. There is evidence that physicians' interactions with pharmaceutical companies negatively affect their prescribing patterns. The objective of this study was to systematically review the extent of the relationship between physicians and pharmaceutical companies in low- and middle-income countries (LMICs). Methods: Studies assessing the extent of any type of interaction between practicing physicians and pharmaceutical companies were eligible. We searched MEDLINE and EMBASE databases in July 2016. Reviewers worked in duplicate and independently to complete study selection, data abstraction and assessment of methodological features. We summarized the findings narratively. Results: We included 11 eligible studies (7 quantitative and 4 qualitative). Quantitative studies found that pharmaceutical company representatives visited at least 90% of physicians. Printed material, stationery items and drug samples were the most frequently received gifts. Two of the studies assessing direct payment found percentages of 16 and 5%, respectively. Findings of qualitative studies were consistent with those of quantitative studies. In addition, they revealed an increasing tendency for pharmaceutical companies to provide expensive personal gifts, sponsor social events and offer cash as inducements to physicians based on their demands. They also identified building personal relationships, creating a sense of indebtedness and emotional blackmailing as commonly used techniques to influence physicians. Conclusion: A relatively high percentage of physicians in LMICs interact with pharmaceutical companies. Findings have implications for policy and practice, given the current extent of interaction is likely affecting the prescribing habits and professional behaviour of physicians.
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In all countries, pharmaceutical companies target health care professionals through marketing strategies that may include gifts, free meals and travels, and drug samples.
“In all countries, pharmaceutical companies target health care professionals through a series of marketing strategies, which may involve gifts, free meals and travels, and provision of drug samples 246,247 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [246]
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- Authors
- Fadlallah, R., Alkhaled, L., Brax, H., Nasser, M., Rajabbik, M. H., Nass, H., Kahale, L. A., & Akl, E. A.
- Affiliations
- American University of Beirut (LB)
- Saint Joseph University (LB)
- Beirut Arab University (LB)
- Damascus University (SY)
- Corresponding author
- Akl, Elie A
- Venue
- European Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11-20
- Volume
- 28
- Issue
- 2
- Pages
- 224-230
- ISSN
- 1101-1262 (ISSN-L)
- 1464-360X
- OpenAlex
- W2770400875
- Cited by
- 30
- References
- 36
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 1
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- pharmaceutical industry, low- and middle-income countries, physician prescribing, conflicts of interest, pharmaceutical samples
- MeSH terms
- Attitude of Health Personnel, Developing Countries, Drug Industry, Humans, Interprofessional Relations, Practice Patterns, Physicians', Physicians, Poverty, Conflict of Interest, Gift Giving, Marketing
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