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Table 5 Barriers to ethical promotion of pharmaceuticals in Pakistan; MD’s perceptive

From: Perceptions of and barriers to ethical promotion of pharmaceuticals in Pakistan: perspectives of medical representatives and doctors

Questions on barriers in ethical promotion Medical doctors (MDs), n = 51 (%) p values
Strongly disagree Disagree Neutral Agree Strongly agree
Lack of external accountability can be a reason of unethical practices 0 (0) 0 (0) 0 (0) 31 (61) 20 (39) 0.35
Doctors are incentivized to generate business by over investigation and treatment of patients at their mercy, medically and financially 7 (13.7) 8 (15.7) 10 (19.6) 15 (49) 11 (21.6) 0.42
Price war among pharmaceuticals 0 (0) 0 (0) 0 (0) 28 (55) 23 (45) 0.24
Out of competition companies resort to unethical promotion to maximize the profits 0 (0) 0 (0) 0 (0) 25 (49) 26 (51) 0.66
Lack of interests in research and study 0 (0) 0 (0) 0 (0) 25 (49) 26 (51) 0.21
Company’s pressure to achieve sale targets 0 (0) 0 (0) 0 (0) 21 (41) 30 (59) 0.59
Low quality products need unethical push 0 (0) 0 (0) 0 (0) 21 (41) 30 (59) 0.27
Job insecurity if sales targets not met 0 (0) 0 (0) 0 (0) 17 (33) 34 (67) 0.42
Non-existence of doctor-patient-pharmacist loop 0 (0) 0 (0) 0 (0) 20 (39) 31 (61) 0.35
Prescribing by brand names 0 (0) 4 (8) 1 (2) 24 (47) 22 (43) 0.13
Doctors are materialistic lacking ethical and moral values 1 (2) 13 (25) 1 (2) 16 (31) 20 (39) 0.56
Sales managers not only condone unethical promotion by MRs but also encourage it 0 (0) 0 (0) 0 (0) 23 (45) 28 (55) 0.02*
Low salaries, for incentives MRs opt un-ethical promotion 0 (0) 0 (0) 0 (0) 23 (45) 28 (55) 0.24
Junior doctors use pharma companies to promote their business (clinic renovation, foreign trips) and clinical practice (speakers at the seminar, free camps) 2 (4) 5 (10) 1 (2) 16 (31) 27 (53) 0.29