Ethical interventions fail to stop incentivised prescriptions in Pakistan: study

#Ethical #interventions #fail #stop #incentivised #prescriptions #Pakistan #study

ISLAMABAD: Incentive-driven prescribing, a practice where doctors receive benefits from pharmaceutical companies in exchange for prescribing advanced drugs, is alarmingly common in Karachi, according to a landmark study published in BMJ Global Health.

The study was conducted by a collaborative team of researchers from several leading institutions around the world, including London School of Hygiene and Tropical Medicine (LSHTM), UK, Aga Khan University (AKU), Karachi and Sindh Healthcare Commission, Karachi. . , Pakistan. The lead researchers were Dr. Mashal Khan from LSHTM, Dr. Muhammad Naveed Noor from AKU, and Afifah Rehman Shepherd from LSHTM, supported by a wide range of international researchers and local experts based in Pakistan.

Despite implementing a multifaceted educational intervention aimed at reducing such practices, research found little evidence of significant change in physician behavior.

Published in BMJ Global Health, this randomized controlled trial surreptitiously assessed how private doctors in Karachi interact with pharmaceutical sales representatives. Data collectors pose as representatives of a fictitious pharmaceutical company, offering incentives ranging from cash payments to clinic renovations. Notably, more than 40 percent of physicians who attended the placebo seminar readily agreed to an incentive-linked prescription. Of those who experienced the intervention, more than 30 percent still engaged in such practices.

The study, which enrolled 419 private physicians operating for-profit primary care clinics, divided participants into intervention and control groups. While both groups attended professional development seminars, only the intervention group received targeted sessions addressing ethical prescriptions. Reinforcement messages, such as motivational materials and ethical prescribing guidelines, were also sent to intervention participants during the six weeks. Despite these efforts, the intervention did not significantly reduce the proportion of physicians accepting incentives.

Dr. Khan and his colleagues highlighted an important problem: Many of the doctors who refused to be associated with the fictitious company were already involved in other pharmaceutical deals. This points to deep systemic problems in Pakistan’s healthcare sector, where profit motives often override patient welfare.

The study revealed that financial incentives were most accepted, followed by medical equipment and leisure travel. Doctors cited the pressure to generate income and the normalization of such practices during medical training as key factors sustaining these deals. The results show that educational interventions alone are insufficient to tackle this problem.

The research team included experts from institutions including LSHTM, AKU, and Sindh Healthcare Commission. Other contributors included Nina van der Mark, Afshan Khursheed Isani, Ahsan Q. Siddiqui, Charles Opondo, Faisal Ziauddin, and many others.

Dr. Khan emphasized that a multi-pronged approach is needed to tackle the problem, including a strong regulatory framework, penalties for non-compliance, and mandatory ethics training during medical education. The authors called for global attention to the challenge of stimulated prescribing, urging policymakers to implement more stringent oversight of pharmaceuticals and medical practices.

Studies to ensure ethical health care practices, protect patient welfare, and restore confidence in the medical profession. therefore emphasizes the urgent need for systemic reforms.