Medicines are used to treat an increasingly wide range of health problems and represent a considerable potential benefit to patients’ health and to health care services. However, when used inappropriately, their harmful effects and costs may outweigh benefits. Pharmaceutical companies must compete for product sales and market share, and this has led to an increasing amount of spending on drug promotion aimed at health professionals and the public. Drug promotion has been found to influence behaviour, with most research pointing to a negative effect on the appropriateness of drug prescribing and use.

Unethical drug promotion takes many forms, including inappropriate inducements to prescribers, failure to provide full product information, misleading presentation by medical representatives, provision of information that is scientifically inaccurate or lacking in balance, and promotional activities disguised as educational symposia and clinical trials. New marketing trends include the promotion of prescription drugs directly to the public (which is illegal in Europe). This is often done covertly through means such as patient help lines, and support to and relationship building with patient groups.

One of the reasons why unethical drug promotion occurs is lack of awareness. Health personnel have insufficient training to see promotion for what it is and to critically appraise it. Consumers also lack access to reliable and objective medicine information, and to education to critically evaluate drug promotion and basic principles of rational drug use.

The HAI/WHO (World Health Organization) drug promotion database (www.drugpromo.info) currently contains 2700 entries on material that describes, analyses, reports on or comments on any aspects of drug promotion. This database will be updated and further developed in 2004/2005. A review of database material found that only a few papers have been published describing programs to teach health professionals or students to critically assess drug promotion. Therefore, HAI Europe and WHO are working together to develop a global inventory of educational initiatives to teach medical and pharmacy students about drug promotion.