Clinical Pharmacy Department, College of Pharmacy, Baghdad University.
Email: ehab_pharma84@yahoo.com
Received: 27 Sep 2014 Revised and Accepted: 25 Oct 2014
Sir,
In Iraq although that the Ministry of health (MOH) is offering a free medical consultation and treatment for all Iraqi patients, but the shortage of drugs, medical devices and even of medical staff in the public sector, may lead to a difficulty in obtaining such free health care [1] which may result in patient seeking an alternative way for health care through the private sector, so this lead to a high focus in the business of drug and medical devices by pharmaceutical drug companies toward the private sector in Iraq.
There are many registered generic and brand drug companies in Iraq with so many medical representatives (MR) for each company, where as the role of such MR is to promote the products of their pharmaceutical drug company and since there are no limitation in the number of drug companies that could be registered in Iraq, in other words this will mean that there is no limitation in the number of drug companies that will supply the same drug item with just few exceptions, for example nine MR from different drug companies (Roche, Mepha, Kontam, LDP, Julphar, Tabuk, Zentiva, Sanavita, and Deva) were visited a small pharmacy in the west of Baghdad, all of them worked hard to promote their product (Ceftriaxone vial), this number may become larger if the pharmacy were in the center of Baghdad, therefore there are many choices with different quality and prices for each drug which will affect decision making not only to the physician when he/she write the prescription for the patient, but also for the pharmacist and most importantly to the patient in choosing the drug.
So this means that the physician should based on his choice of the drug on clinical evidence to ensure optimum benefit to the patient but unfortunately some other studies found that the physician is affected by advertisement rather than clinical evidence when writing medical treatment for the patient [2]; while in Iraq a study in this regard showed that the physician usually change his/her prescribing pattern by attendance of MRs [3] and this change is directly related to gift administration to the physician [4], so this means that the physician will prescribe the drug of certain drug company for limited period of time then change prescribing to another drug company by the effect of MRs and their gifts, this in turn means that the dispensing of certain drug in the pharmacy will be stopped and thus many packets will remain on the shelf until their expire date, which may result in negative economic effect on the pharmacy budget. On the other hand if the patient who use certain drug for his chronic disease return back for usual follow up to his/her physician, there is a chance that the physician will write a prescription for the patient with same drug but from another company and thus the patient who usually don't know the scientific names of drugs will discard the remaining pills of the previously prescribed drug and start using the new drug which is the same drug but from another company, which again leads the patient to spend more and more. Moreover Iraqi physicians agreed in that there is no any benefit toward patient health status by drug promotion [5].
In conclusion drug promotion in Iraq result in a big loss of resources to the patient, pharmacist and eventually to country economics.
ACKNOWLEDGMENT
To administer of Al-Hamid Pharmacy who facilitate the work for the author in counting medical representative who promote ceftriaxone vial.
REFERENCES