Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan
Introduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmace...
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/12/e016055.full |
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| author | Afifah Rahman-Shepherd Johanna Hanefeld Mishal Khan Charles Opondo Sameen Siddiqi Virginia Wiseman Iqbal Azam Wafa Aftab Sadia Shakoor Amna Rehana Siddiqui Rumina Hasan Zafar Mirza Muhammad Naveed Noor Sabeen Sharif Khan Nina van der Mark Afshan Khurshid Isani Ahson Q Siddiqi Faisal Ziauddin Faiza Bhutto Natasha Ali Robyna Irshad Khan Syed Ahmed Raza Kazmi Zainab Hasan |
| author_facet | Afifah Rahman-Shepherd Johanna Hanefeld Mishal Khan Charles Opondo Sameen Siddiqi Virginia Wiseman Iqbal Azam Wafa Aftab Sadia Shakoor Amna Rehana Siddiqui Rumina Hasan Zafar Mirza Muhammad Naveed Noor Sabeen Sharif Khan Nina van der Mark Afshan Khurshid Isani Ahson Q Siddiqi Faisal Ziauddin Faiza Bhutto Natasha Ali Robyna Irshad Khan Syed Ahmed Raza Kazmi Zainab Hasan |
| author_sort | Afifah Rahman-Shepherd |
| collection | DOAJ |
| description | Introduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors’ engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan.Methods We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars.Results We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors’ age, sex and clinic district, there was no evidence of the intervention’s impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192).Conclusions This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere. |
| format | Article |
| id | doaj-art-5d34af0ba2cc42479189ef9afcbe12f1 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-5d34af0ba2cc42479189ef9afcbe12f12025-01-17T23:20:10ZengBMJ Publishing GroupBMJ Global Health2059-79082024-01-0191210.1136/bmjgh-2024-016055Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in PakistanAfifah Rahman-Shepherd0Johanna Hanefeld1Mishal Khan2Charles Opondo3Sameen Siddiqi4Virginia Wiseman5Iqbal Azam6Wafa Aftab7Sadia Shakoor8Amna Rehana Siddiqui9Rumina Hasan10Zafar Mirza11Muhammad Naveed Noor12Sabeen Sharif Khan13Nina van der Mark14Afshan Khurshid Isani15Ahson Q Siddiqi16Faisal Ziauddin17Faiza Bhutto18Natasha Ali19Robyna Irshad Khan20Syed Ahmed Raza Kazmi21Zainab Hasan221 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK8 Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK3 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK3 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan3 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan2 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan5 Jinnah Sindh Medical University, APPNA Institute of Public Health, Karachi, Pakistan2 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan14 School of Universal Health Coverage, Professor of Health Systems at Shifa Tameer-i-Millat University, Islamabad, Pakistan2 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan2 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK6 Health Department, Government of Sindh, Karachi, Pakistan7 Sindh Healthcare Commission, Karachi, Pakistan10 Department of Medicine, Ziauddin University, Karachi, Pakistan7 Sindh Healthcare Commission, Karachi, Pakistan2 Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan11 Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan7 Sindh Healthcare Commission, Karachi, Pakistan7 Sindh Healthcare Commission, Karachi, PakistanIntroduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors’ engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan.Methods We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars.Results We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors’ age, sex and clinic district, there was no evidence of the intervention’s impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192).Conclusions This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere.https://gh.bmj.com/content/9/12/e016055.full |
| spellingShingle | Afifah Rahman-Shepherd Johanna Hanefeld Mishal Khan Charles Opondo Sameen Siddiqi Virginia Wiseman Iqbal Azam Wafa Aftab Sadia Shakoor Amna Rehana Siddiqui Rumina Hasan Zafar Mirza Muhammad Naveed Noor Sabeen Sharif Khan Nina van der Mark Afshan Khurshid Isani Ahson Q Siddiqi Faisal Ziauddin Faiza Bhutto Natasha Ali Robyna Irshad Khan Syed Ahmed Raza Kazmi Zainab Hasan Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan BMJ Global Health |
| title | Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan |
| title_full | Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan |
| title_fullStr | Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan |
| title_full_unstemmed | Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan |
| title_short | Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan |
| title_sort | doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention a pragmatic randomised controlled trial in pakistan |
| url | https://gh.bmj.com/content/9/12/e016055.full |
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