Abstract
The objective of the proposed study is to determine whether pharmaceutical companies in the UK should be able to sell more drugs than they currently do. Essentially, the proposed research seeks to establish whether the tactics used by pharmaceutical companies in the UK lead to medicines being oversold. The proposed research will use a qualitative research method employing semi-structured interviews with 30 pharmacists and doctors practicing in London.
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Should UK Pharmacies Be Able to Sell More Medicines than They Currently Do?
Introduction
The pharmaceutical industry makes significant contributions to the UK economy in terms of gross domestic product. Despite the higher profit margins reported by pharmaceuticals in the UK and their importance to the economy, malpractice is a common feature of the pharmaceutical industry, which is evident in the billions of pounds in fines. Guldal & Semin argue that the pharmaceutical industry has the main responsibility of developing medicines to be used to save lives and relieve human suffering rather than making profits. In this respect, pharmaceutical firms have managed to produce a significant proportion of medicines used by humankind; however, they have turned considerable profits in the process, albeit through illegitimate methods. Pharmaceutical companies are reporting the highest profit margins, on average as high as 42%, when compared to other sectors such as banking (29%), automotive (10%), oil and gas (24%) and media (18) among others. Brennan et al. Argue that the kind of profit margin reported in the pharmaceutical sector cannot be justified, which can be attributed to a number of factors such as overpricing and courting doctors to prescribe drugs. Big pharmaceutical companies in the UK are known to issue bribes to doctors so that the latter recommend their drugs to patients. Apart from colluding with doctors, pharmaceutical companies are also conspiring with chemists in the UK to overprice their medicines. Other illegitimate methods used to increase the sales of medicines include wrong promotions and misbranding. The outcome is an increase in the number of medicines sold. In this regard, there is the need to determine whether such practices adopted by pharmacies lead to medicines being oversold, which is the focus of this research study. The rationale for the selection of this topic is the increase in the malpractices adopted by pharmaceutical companies to raise their sales.
Research Questions
The primary objective of this study is to determine whether pharmaceutical companies in the UK should be able to sell more drugs than they currently do. Essentially, this study seeks to establish whether the current sales of medicines by pharmacies in the UK can be justified. The following is the research question that will guide the study:
Should UK pharmacies be able to sell more medicines that they currently do?
Literature Review
There is no doubt that medicines play a crucial role with respect to the attainment of good health; however, it is imperative for medicines to be used rationally. When in need of treatment, it is important for a patient to be provided with the right medication and in the correct dosage. Healthcare practitioners, including pharmacists and doctors, play a vital role in making sure that people use medicines appropriately. Pharmacists and doctors have been considered gatekeepers to healthcare; as a result, they are expected to evaluate various treatment options available and take into account the likely harm and benefits. Nevertheless, the recent past has seen an increase in the concerns raised regarding the relationship existing between healthcare practitioners and the pharmaceutical sector, especially with respect to the influence that the industry has on the dispensing and prescription decisions made by pharmacists and doctors. This impact has been reported to result in suboptimal medication and treatment choices, which have poor health outcomes for patients.
Regardless of the essential nature of medication and treatment decisions as well as the pivotal role that pharmaceutical promotions play in influencing the medication and treatment options, health professionals often receive little or no information on how they can evaluate pharmaceutical promotion, including its effect on their behaviour. Pharmacy and medical students usually commence having contact with the pharmaceutical sector during the early stages of their training through avenues, such as presentations made by drug sales representatives, gifts and sponsored activities by pharmaceutical companies among others. A survey undertaken by Sierles et al. Revealed that most pharmacy and medical students were of the view that pharmaceutical promotions were unlikely to have an impact on their dispensing and prescribing decisions. Moreover, the study showed that majority of pharmacy and medicine students in their final year were not aware of the incentives provided by pharmaceutical companies to pharmacies for the purpose of increasing sales. Many authors agree that the association between pharmacy, medicine and pharmaceutical companies exists, although students get minimal education regarding the manner in which these interactions are likely to influence their decisions and how they can manage them.
Owing to the influence that pharmaceutical companies have on health professionals, tension exists between commercial aims and health outcomes. Medicines have been considered a crucial component of healthcare services. The use of medicines experienced an immense growth in the course of the 20th century following the invention of effective medicines such as antiretroviral, painkillers, anaesthetics, and antibiotics among others. Medicines have the capability of curing illnesses, relieving symptoms, and preventing contraction of diseases in the future. Medicines should be used rightly, in the right dosage and when required; moreover, it is vital to avoid the intake of unnecessary medicines and those that are less likely to lead to positive health outcomes. In addition, the appropriate medicine requires the selection of proper treatment having the best safety profile and effectiveness relative to the available alternatives. In order to make the appropriate treatment decision, it is imperative for a health practitioner to be well-informed of the patients condition, preference and life circumstances as well as access objective comparative data regarding the benefits and harms associated with the diverse available treatment alternatives. The pharmaceutical sector in most countries, including the UK, plays a pivotal role with respect to developing, producing and distributing medicines. In the UK, the pharmaceutical sector is also a primary financer of medical researches and continuing medical education. Nevertheless, there is tension existing between the need to increase medicine sales on the market, which is becoming increasingly competitive, and the need to deliver quality care. In other words, there is a conflict of interest between the commercial goals of pharmaceutical companies and the economic, medical and social needs of healthcare providers in selecting drugs rationally.
The influence of pharmaceutical companies prevents health professionals from making rational decisions when determining the course of treatment, including the medicines prescribed and dispensed. Because of the widespread influence of pharmaceutical companies, there have been calls from physicians educators to make sure that academic medical centres are independent. A survey by Campbell et al. showed thatabout 90 percent of physicians revealed some form of association with pharmaceutical companies such as gifts (80 percent), free medicine samples (80 percent), paid conferences and meetings (40 percent) and paid consultants (30 percent). In the UK, physicians see at least one drugs sales representative on a weekly basis. The study indicated that, regardless of the fact that physicians were of the belief that drugs sales representatives do not have influence on the dispensing and prescribing decisions, majority of them sourced information pertaining to drugs from advertisements and brochures.
Pharmaceutical companies spend a significant amount of money on promotional activities such as sales representatives, meetings, e-promotions, journal advertisements, samples, sponsored education, financing core physician leaders, market seeding researches, public relations campaigns and pharmacy discounts. All these promotional activities have the primary objective of boosting medicines sales. A number of studies have explored the relationship between these tactics, quality of care and sales increase. For instance, Caplovitz reported that physicians who attended sponsored lectures prescribed more medicines of the hosting companies when compared to those who did not. In addition, the author indicated that meetings with drug sales representatives yielded more medicine sales when compared to meetings without them. Free medicine samples have also been found to exert an impact on the prescribing and dispensing decisions made by physicians; therefore, the prohibition of free medicine samples can help to improve health care quality. From the literature review, it is evident that promotional activities by pharmaceutical companies have an impact on professional practice, which, in turn, leads to increased sales. An issue of concern is whether an increase in drug sales contributes to appropriate drug use and quality of care. As a result, there is the need to establish whether pharmacies are overselling drugs due to the influence of pharmaceutical manufacturers.
Methodology
Research Philosophy
Research philosophy denotes the manner in which the researcher perceives the world, including the assumptions related to human knowledge and the nature of realities Research philosophy has a pivotal role in influencing how the research problem is tackled relative to the research design. Essentially, all methodological aspects are affected by the research philosophy adopted to guide the study. According to Saunders, Lewis and Thornhill, it is important for scholars to determine the manner in which they perceive the world under investigation since this aids in making the appropriate research philosophy to guide the study. Three aspects are considered when choosing the research philosophy. They include ontology, epistemology and methodology. Ontology denotes the views of the researcher with respect to the nature of reality. Epistemology comprises the standpoint of the researcher in regard to what constitutes an acceptable human knowledge. Methodology involves the procedures and techniques employed by the researcher in collecting data to address the research question. Saunders, Lewis and Thornhill outlinedfour research philosophies, which can be adopted for any study, and they include positivism, realism, pragmatism and interpretivism. The present research adopted the philosophy of interpretivism, which suits the studies seeking to have rich insights regarding a research issue. The choice of interpretivism draws the need to perform a critical analysis of the perceptions and views of health professionals in the UK, especially doctors and pharmacists, regarding how pharmaceutical companies attempt to increase sales by influencing their prescription and dispensing decisions. Given the nature of the current study, the positivist research philosophy was not appropriate because of the subjective nature of the influence of pharmaceutical companies on healthcare professionals: various professionals experience different levels of influence during promotional activities of pharmaceutical companies. For instance, some doctors may be receptive to bribery, whereas others may have negative views regarding it. Therefore, the views of doctors and pharmacists in the UK will be compared.
Interpretivist research focuses on situational details, social construction of knowledge and the use of qualitative methods that involve comprehensive investigations rather than generalisations. In line with this, the current study seeks to provide in-depth insights regarding the meanings of the situation under study (impact of pharmaceutical companies) based on the outlook of people in that situation (doctors and pharmacists). Interpretivist research is based on the subjective nature of reality, which creates the need to make use of words rather than statistics in the presentation of the findings. Moreover, interpretivist philosophy requires the use of a research design that is flexible and adaptable in order to accommodate unexpected themes, patterns and trends that may emerge when performing the study.
Research Approach
Two research approaches exist for any study: induction and deduction. Deductive approach is used when evaluating a theoretical assertion (hypothesis) based on findings that can be utilised to confirm or reject the assertion. On the other hand, the inductive approach is usually employed in the development rather than testing of theories and makes use of research questions. It helps to clarify the issue under investigation; therefore, it suits best the current research that is mostly explorative. Inductive approach often involves the use of qualitative research methods in order to gather sufficient data that can be utilized to understand the phenomenon under investigation. In this research, emphasis was placed not on generalizing the findings but understanding the issue. Essentially, the reason for the approach to be used in the research will be characterized by collecting data in order to develop a conceptual model. The latter can be used to understand how pharmaceutical companies increase sales through healthcare professionals and whether such sales are justified. This information will help to conclude whether or not pharmacies in the UK should be able to sell more medicines that they currently do.
Research Method
This study will make use of a qualitative research method. The choice of the method is explained by the explorative nature of the research, which seeks to discover new information. The nature of the study does not suit the quantitative research. Moreover, the qualitative research will be administered using semi-structured interviews with pharmacists and doctors in London. Semi-structured interviews have been proven effective in offering detailed information by providing an opportunity for the researcher to clarify and finalize the incomplete responses. Moreover, the qualitative and explorative nature will require a flexible approach to collecting data; this will be facilitated by semi-structured interviews. The latter will focus on various ways through which pharmaceutical companies try to influence health professionals to increase their sales, whether these tactics work, and their perceptions whether these tactics contribute to overselling of medicines.
Study Population and Sampling
The population for this study will comprise healthcare professionals in the UK, especially pharmacists and doctors since they are the ones who are involved in the prescription and dispensing of medicines. The sample for the study will be selected using the purposive sampling, which involves selecting participants based on the purpose of the research. In this regard, participants will be selected based on their knowledge on the topic. Moreover, they will be drawn from pharmacists and doctors practicing in London. Therefore, doctors and pharmacists will be selected because of their direct involvement in the prescription and dispensing of medicines. The study targets to interview 30 respondents. For qualitative studies, there are no definite rules for determining the sample size; nevertheless, it is imperative to achieve data saturation.
Validity/Reliability
In order to guarantee the validity and reliability of the study, the researcher will make sure that only doctors and pharmacists will take part in the study. In addition, data triangulation will be used, which will involve comparing the responses from participants with secondary literature for consistency.
Ethical Issues
A number of ethical considerations will also be taken into account. First, the study will guarantee the anonymity of participants and the confidentiality of information provided by them. In this respect, the study insures that no personal data that can be used to identify participants will be gathered. In addition, the information collected during the research will be saved on a password-protected computer. Second, the principle of voluntary participation will be taken into account, which means that participants will have the right to engage in the research at their own will and quit at any point. No participant will be coerced into partaking in the research. In addition, an informed consent form telling the participants the purpose of the research will be provided.
