A nationwide assessment of the knowledge, attitude and practices among Filipino physicians on ethical relations with the pharmaceutical industry

Abstract

Physician interaction with the pharmaceutical industry has effects on drug prescribing practices. Policy regarding prescribing practices is important in countries with high drug prices such as the Philippines.  In 2015, the Philippine Department of Health (DOH) and the Food and Drug Administration (FDA) adopted the Mexico City Principles (MCP), as an enforceable code of business ethics guiding pharmaceutical industry engagement with physicians. Although the MCP applies to the pharmaceutical industry, identifying physicians’ baseline knowledge, attitudes, and practices with regard to ethical relations with the pharmaceutical industry helps elucidate the former’s vulnerability to inducement. Information from the literature and consultations with stakeholders was incorporated to develop a validated survey tool. After pre-testing, the survey was deployed through medical societies and professional networks, following purposive maximum variation sampling. Around 30% (2,030 of an estimated 6,900 physicians) responded. Only 53.0% (1,080) of the respondents were aware of the MCP and 334 (16.45%) reported that they had not previously heard of it. There was a favorable attitude towards industry relations perceived as benefitting patients and facilitating information exchange, even when respondents recognized that these interactions influenced an increase in medicine prescribing. Respondents reported that peers practice “excessive” interactions with pharmaceutical companies; however colleagues and role models in their workplaces deemed these acceptable. Awareness of the concept of conflict of interest was low.  These findings suggest the need to increase physician’s awareness of the MCP as rules that the pharmaceutical industry must follow. The awareness must be accompanied by recognition that industry influences on their practice affect patient care. An enabling environment and role modeling are crucial to institute ethical attitudes and practices in healthcare education and workplaces. Recognition and management of pharmaceutical industry-related conflict of interest should be introduced early among would-be physicians through training institutions, hospitals and professional societies.