Analysis of Drug Promotional Literatures distributed by pharmaceutical companies in Nepal

[Speaker] Pravin Prasad:1
[Co-author] Sangha Ratna Bajracharya:1, Satish Deo:1
1:Department of Clinical Pharmacology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal

All activities by manufacturers and distributors to induce the prescription, supply, purchase and/or use of medicinal drugs is defined as drug promotion. Drug Promotional Literatures (DPLs), though are usually relied upon for drug promotion, studies have shown them to contain several pitfalls. This has led WHO to establish WHO Ethical Criteria for Medicinal Drug Promotion (WHO-ECMDP) in 1988. Based on this guideline, several regional and national guidelines have been formulated. Though laws for drug promotion is existent, problems with DPLs in Nepal has been documented. This study was carried out to analyse the DPLs distributed by pharmaceutical companies in Nepal as per WHO-ECMDP.
A descriptive (cross-sectional, observational) study was conducted at Department of Clinical Pharmacology, Maharajgunj Medical Campus, TU over a period of one year from 17 September 2016 to 16 September 2017, during which pharmaceutical companies registered in Department of Drug Administration, Kathmandu and consenting for the study were requested to provide ten unique DPLs of their products. Collected DPLs were classified and analysed for inclusion of essential information as per WHO-ECMDP, level of biasness, inclusion of tables and illustrations and referneces used in them.
A total of 48 pharmaceutical companies providing 372 DPLs meeting the inclusion criteria were included in the study. DPLs promoting antimicrobial agents, oral formulations, single drug formulation and of advertisement type were commonly received. Adherence to criteria concerned with positive attributes of the promoted medicine was found to be higher, most of the DPLs adhered to 5-8 criteria of WHO-ECMDP (grade B). Most of the DPLs contained tables/illustration in the study. Only few DPLs contained information related to cost of the formulation. DPLs varied with the number of references cited in them, a total of 801 references were found to be cited in DPLs. References with their full text freely available were analysed further and several problems were identified.
Adherence to WHO-ECMDP was found to vary when DPLs were classified as per pharmaceutical company, type of formulation being promoted, type of DPLs. Tables or illustrations used in DPLs also varied similarly. References though used in DPLs, claims were not verifiable at times.
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