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Beliefs and practices of physicians in Lebanon regarding promotional gifts

and interactions with pharmaceutical companies

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DOI: 10.26719/emhj.24.027

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Research article EMHJ – Vol. 30 No. 2 – 2024

Beliefs and practices of physicians in Lebanon regarding promotional

gifts and interactions with pharmaceutical companies
Issam Shaarani1, Jida Hasbini1, Reem Farhat1, Nour Safawi1, Jamil Sleiman1, Alaa Kassem Hammoud1, Tamara Fayad1, Dana Khazaal1, Oubaida Elkhatib1
and Hussein Berjaoui1

Faculty of Medicine, Beirut Arab University, Beirut, Lebanon (Correspondence to Hussein Berjaoui: [email protected])
1

Abstract
Background: Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by
physicians, yet there is limited published information evaluating its impact on healthcare.
Aim: This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their
interactions with representatives of pharmaceutical companies.
Methods: This cross-sectional study was conducted between December 2019 and January 2020 through an email-based
questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment
was done using a validated tool and data analysis was conducted using SPSS version 26.0.
Results: Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives
of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once
a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts
accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by
physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical
companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed
them to accept gifts from pharmaceutical companies.
Conclusion: Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could
have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers
for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in
Lebanon.
Keywords: clinical practice, physicians, pharmaceutical companies, promotional gifts, medical ethics, pharmaceutical representatives, Lebanon
Citation: Shaarani I, Hasbini J, Farhat R, Safawi N, Sleiman J, Hammoud AK, et al. Beliefs and practices of physicians in Lebanon regarding promotional
gifts and interactions with pharmaceutical companies. East Mediterr Health J. 2024;30(2):116–124. https://doi.org/10.26719/emhj.24.027.
Received: 16/06/23; Accepted: 05/10/23
Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the
Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Background likelihood of influence – including changes to physicians’

prescribing behaviours – when there is an exchange of
Pharmaceutical companies spend a lot of money for
promotional gifts, even those of negligible value (9).
promotional purposes; it has been estimated that the
global worth of promotional activities is around US$ Lebanon’s healthcare sector comprises both public
300 billion a year (1). This is almost twice the amount and private healthcare providers. The National Social
of money spent by these companies on research and Security Fund (NSSF), established in 1963, caters to
development, as often asserted by relevant professional 80% of hospital expenses, including costly medical
societies (2). interventions, offering a notable benefit to a considerable
A pharmaceutical company representative (PCR) is proportion of the populace (approximately 42.7%).
an employee of a pharmaceutical company who would While Lebanon’s healthcare system was once
visit practicing doctors regularly to advertise a certain renowned regionally, the aftermath of the 1975 civil war
product (3). Frequent and regular PCR visits are the most led to a decline and a shift of control towards the private
important and influential tool used by pharmaceutical sector and non-government organizations (NGOs)(10).
companies (4,5). During these visits, the representative Since then, nearly half (48%) of the total public health
provides details about the product (6) and often presents spending has been used for hospitalization within the
gifts to influence the decision of the physician to use the private sector (11); and 80% of the hospitals in Lebanon are
product (3). private (12). This sector has been shown to over-medicalize,
In several studies, most doctors reported accepting focusing more on the younger, healthier population
gifts from pharmaceutical companies (7); the blind spot and their immediate demands, such as procedures and
concept in conflicts of interest has been associated with prescriptions, than on primary preventative measures
such behaviour (8). Substantial evidence reveals the and continuity of care for chronic diseases (13). Of the

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Research article EMHJ – Vol. 30 No. 2 – 2024

drug expenditures within private practice, 79% is out-of- beliefs; and physicians’ knowledge of relevant LOP laws.
pocket payment by the patient (12). The questionnaire was pretested on 10 physicians and a
In Lebanon, the rate of prescription inaccuracies is up few modifications were made to ensure validity.
to 40%; of these inaccuracies, 9% is seen as unnecessary
Validated tool
prescription as a consequence of promotional activities
(5). Due to the change in prescribing behaviours, the A validated assessment tool was developed to measure
ethical issue has been of concern to both promoting the gift relationship between pharmaceutical companies
companies and physicians, as well as the regulatory and physicians (14). The tool studied the extent of gift
authorities (5). giving and receiving (14), which was validated based on
the extent of giving (15). It consisted of 22 close-ended
The impact of these interactions on the prescription
statements categorized into 7 belief constructs (7-likert
practice of physicians is well established, although
scale) (14). Physicians were asked to specify their level
precise knowledge of the extent to which Lebanese
physicians interact with and accept promotional of agreement or disagreement using a 0–6 scale, where
gifts from pharmaceutical companies is lacking, as is 0=strongly disagree and 6=strongly agree (14).
an understanding of their beliefs in this regard. We Statistical analysis
hypothesize that the majority of Lebanese physicians
have interactions with pharmaceutical companies in Analysis was conducted using SPSS 26.0. Descriptive
a way that is affecting their practice and prescription data was reported as mean ± standard deviation for
patterns. continuous data, and as numbers and percentages for
categorical data. P<0.05 was considered significant.
This study assessed the beliefs and practices of Different statistical tests were used wherever appropriate,
Lebanese physicians regarding promotional activities such as Chi-square test for categorical variables, T-test
and interactions with pharmaceutical companies. for continuous variables, and Kendall Tau for ordinal
variables.
Methodology
Study design and setting Results
This cross-sectional study was conducted using an Participants' demographics
online-based questionnaire through Lime Survey, sent
Most respondents were male (65.7%) and the mean age
by email to physicians who are enrolled in the Lebanese
was 45 years. The majority of physicians were from
Order of Physicians (LOP); to be able to practice, Lebanese
Beirut (59.3%), followed by Mount Lebanon (33.2%) and
physicians must be enrolled in LOP. Ethical approval for
North Lebanon (22.8%). Most were attending physicians
the study was obtained from the institutional Review
(94.8%) with more than 10 years of experience (56.7%)
Board of Beirut Arab University.
(Table 1).
Sample size Years of experience was not significantly correlated
Since we had no available data on the proportion of with the acceptance of pharmaceutical gifts (P=0.219).
physicians accepting promotional gifts, we assumed an Internal medicine and its subspecialties (32.5%), family
expected proportion of 50% of physicians. For a power medicine/general practice (14.9%) and general surgery
of 80%, margin of error of 5% and a confidence interval (13.4%) were among the most common fields practiced.
of 0.95, the estimated sample size was set at 385 using Physicians most commonly practiced in private
n=Zα/2*p*(1−p)/MOE-squared. hospitals (64.2%), university hospitals (50.7%) and private
clinics (45.5%). There was significant association between
Recruitment of participants working in a private hospital and seeing a PCR more
An online questionnaire was sent to 5936 physicians frequently (P<0.001).
in Lebanon whose names and email addresses were
provided by LOP. Lime Survey was used to establish, Interaction with pharmaceutical companies
send and retrieve the questionnaire. An initial invitation Only 6.3% of the physicians had no interaction with
email was sent to study participants between December PCRs (Table 2). Of those who interacted with PCRs, 28%
2019 and January 2020. The consent form was attached, reported once-weekly interactions and 31.7% reported
and participants consented electronically to participate interacting even more frequently, although not daily.
in the study. Reminder emails were sent every 2 weeks, The figure dropped to 14.2% for daily interactions.
with a total of 3 emails. The physicians participating in
the survey remained anonymous. Promotional gifts
Among responding physicians, 69.3% thought that most
Questionnaire of their colleagues accepted gifts from PCRs, which
The questionnaire was divided into 4 parts: demographics; was concordant with further results that showed most
physicians’ practices with regard to interactions with (70.4%) respondents admitted accepting gifts from PCRs.
pharmaceutical companies; validated tool to assess Interestingly, there seemed to be self-awareness of

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Table 1 Respondents’ demographic and practice characteristics (n=268)

General characteristics Variable n (%)
Gender Male 176 (65.7)
Female 92 (34.3)
Age Mean (±SD) 45.01 ± (11.647)
Years of experience 1–5 years 71 (26.5)
5–10 years 45 (16.8)
>10 years 152 (56.7)
Practice setting Hospital-based (private hospital) 172 (64.2)
Hospital-based (public/government) 45 (16.8)
Academic centre (university hospital) 136 (50.7)
Private clinics (yourself only) 122 (45.5)
Polyclinic 43 (16.0)
Primary health care centre 56 (20.9)
Physician’s position Attending physician 253 (94.8)
Resident/fellow 14 (5.2)
Specialty Anaesthesiology 15 (5.6)
Radiology 7 (2.6)
Obstetrics and gynaecology 23 (8.6)
Paediatrics 17 (6.3)
Family medicine/GP 40 (14.9)
Internal medicine 87 (32.5)
General surgery 36 (13.4)
Ophthalmology 5 (1.9)
Psychiatry 30 (11.2)
Laboratory medicine 4 (1.5)
Others 4 (1.5)
Governate of practice setting Akkar 8 (3.0)
Baalbek-Hermel 6 (2.2)
Beirut 159 (59.3)
Beqaa 13 (4.9)
Mount Lebanon 89 (33.2)
North Lebanon 61 (22.8)
Nabatieh 8 (3.0)
South Lebanon 17 (6.3)

prescribing habits, as 84.9% of the physicians believed with PCRs, that relationship was directly proportional
that receiving gifts affected their prescription habits. and statistically significant (P<0.001).
Of those who worked in a private clinic, 76.9% Half of the physicians surveyed believed there
reported that they had ever received a promotional gift, should be a maximum value for a promotional gift to
as compared to 65.1% of those who did not work in a be considered acceptable; the majority suggested a
private clinic (P=0.043). Figure 1 shows the promotional maximum of US$ 100. There was a significant difference
gifts most commonly received by physicians: medication (P=0.032) between those who accepted promotional gifts
samples (94%); stationery items (83.1%); books and journal and those who did not with regard to the maximum value.
subscriptions (80.9%); research funding (79.4%); and Those who accepted promotional gifts mostly believed in
sponsored travel to conferences (73.3%). setting a maximum value (53.5%).
Results show that 89.5% of the physicians who
interacted with PCRs daily accepted promotional gifts.
Clinical encounters
This percentage dropped progressively and significantly In terms of clinical visits, 105 respondents (39.2%) saw
to 23.5% for those who did not interact with PCRs. 0–10 patients per day. This value slightly increased and
When we analysed the association between accepting peaked with the increase of patients, where 107 (39.9%)
pharmaceutical gifts and the frequency of interaction saw 11–20 patients per day. As the number of patients per

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Table 2 Physicians’ responses on interactions with PCRs per day; this number increased significantly (P=0.007) to
(n=268) 31.6% for those who saw a PCR daily.
Variable Answer n (%)
Beliefs about promotional activities
Frequency of physicians’ Daily 38 (14.2)
interactions with PCRs
More than once weekly 85 (31.7) Most physicians moderately agreed (x̅̅=4.65±0.45)
that companies gave them gifts to influence their
Once weekly 75 (28.0)
prescriptions (Table 4). However, physicians slightly
Once monthly 33 (12.3)
disagreed (x̅̅=2.43±0.20) that they were influenced
Less than once monthly 20 (7.5)
by pharmaceutical companies upon receiving a gift.
No interaction 17 (6.3)
Physicians slightly agreed (x̅̅=3.36±0.37) that the gifts
Personal acceptance of Yes 188 (70.4)
they received were a form of professional recognition.
gifts from PCRs
No 79 (29.6)
Most doctors moderately agreed (x̅̅=4.04±0.60)
Other Lebanese physicians <20% 9 (3.4)
accepting gifts from PCRs that receiving gifts was inappropriate, and moderately
21–40% 15 (5.7)
agreed (x̅̅=4.31±0.44) that making their relationship with
41–60% 56 (21.5)
pharmaceutical companies public was an obligation.
>80% 181 (69.3)
Regarding sponsored continuing medical education
Lebanese physicians’ Yes 225 (84.9) (CME) programmes, physicians moderately agreed
prescription affected by
No 40 (15.1)
receiving PCR gifts (x̅̅=4.65±0.56) that sponsored CME events were a
promotional gimmick by pharmaceutical companies.
Of those who accepted pharmaceutical gifts, 40%
day increased, the number of physicians decreased: only believed that receiving gifts was unethical, versus 66.7%
38 (14.2%) saw 21–30 patients per day, and 18 (6.7%) saw of those who did not accept such gifts. This difference
31–40 patients per day. was significant. Similarly, only around 42% of those who
accepted pharmaceutical gifts believed that a physician’s
Regarding prescriptions, 135 physicians (50.4%)
behaviour was liable to change because of the gift, and
wrote 0–10 prescriptions per day. As the number of that gifts are given to doctors to influence, in contrast to
prescriptions written per day increased, the number of 72.0% of those who did not accept gifts.
doctors writing them decreased to 16 (6%) for those who
While 83 physicians (31.4%) believed that the
wrote 31–40 prescriptions per day (Table 3). Among the
Lebanese Code of Medical Ethics allowed them to accept
respondents, 226 (86.9%) gave medication samples to pharmaceutical gifts, 49 (18.6%) did not, and 132 (50%) did
their patients, with the majority (94.3%) doing so to help not know the stance on this issue. Among physicians who
those who could not afford a medication rather than to were unaware of whether the Lebanese Code of Medical
build rapport with patients (5.7%). Ethics allowed accepting promotional gifts, around 70%
Overall, there was a significant increase in the number reported that they had ever accepted a promotional gift.
of prescriptions associated with the increase of PCR Those who believed the code allowed acceptance of
contact. None of the physicians that interacted with a PCR some or all promotional gifts were more likely to accept
less than once a month wrote more than 21 prescriptions promotional gifts. On the other hand, the percentage of

Figure 1 Types of gifts accepted by Lebanese physicians

300

250

200
Percentage

150

100

50

0
Gifts
Medication
samples

Stationery items

Books and

Research

Sponsored Travel
to attend a
conference

Mobiles/Laptops

Direct payment
journal
subscriptions

Free meals
funding

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Research article EMHJ – Vol. 30 No. 2 – 2024

Table 3 Characteristics of the physicians’ clinical encounter (n=268)

Variable Answer n (%)
Number of patients seen per day 0–10 105 (39.2)
11–20 107 (39.9)
21–30 38 (14.2)
31–40 18 (6.7)
Number of prescriptions written per day 0–10 135 (50.4)
11–20 94 (35.1)
21–30 23 (8.6)
31–40 16 (6.0)
Physician gives drug samples to patients Yes 226 (86.9)
No 34 (13.1)
Reason for giving a drug sample to patients To help patients who could not afford a medication 200 (94.3)
To build a good relationship with patients 12 (5.7)

physicians who believed that the Lebanese code did not of the offers presented to physicians by pharmaceutical
allow acceptance of promotional gifts was significantly companies are accepted (1).
lower (around 50%) than those who reported ever For promotional purposes, pharmaceutical companies
accepting a promotional gift (P=0.006). seem to be targeting physicians practicing in the private
sector and at university hospitals. Our findings reveal
that only those who worked in private hospitals had
Discussion significantly more frequent visits from PCRs, and their
The study targeted Lebanese physicians to assess tendency to accept promotional gifts was significantly
their beliefs and practices regarding encounters with higher than their colleagues in the public sector. This
pharmaceutical companies and their promotional preference could be due to the high level of physician
agenda. In many areas of the world, most doctors are autonomy in private practice (17).
visited by PCRs at least once weekly (3). This could be Changes in prescription behaviour, under the
considered problematic, as repeated PCR visits seem to influence of pharmaceutical companies, often causes the
have an increased influence on prescribing patterns (16). physician to overlook cheaper alternatives as they feel
obliged to submit to the promotional party’s benefits (5).
The rate of gift acceptance from PCRs was high Our study showed that physicians moderately agreed that
among Lebanese physicians (70.4%), comparable to they received gifts attempted to influence prescription-
other countries, such as the United States (94%) (8) and related decisions, and most respondents (84.9%) believed
Saudi Arabia (80.1%) (1). Several studies show that most that Lebanese doctors were indeed influenced by

Table 4 Physicians’ beliefs about gifts given by pharmaceutical companies

Constructs Mean±SD
Construct 1
Pharmaceutical companies give gifts to physicians to influence their prescriptions 4.65±0.45
Construct 2
Pharmaceutical companies give gifts to physicians as a form of professional recognition 3.36±0.37
Construct 3
In general, most physicians are influenced in their prescription behaviour by the gifts they receive from pharmaceutical 4.12±0.65
companies
Construct 4
I am influenced in my prescription behaviour by the gifts I receive from pharmaceutical companies 2.43±0.20
Construct 5
Pharmaceutical companies sponsor CME programmes as a promotional gimmick 4.65±0.56
Construct 6
It is inappropriate to accept gifts from pharmaceutical companies 4.04±0.60
Construct 7
The extent of the gift relationship between pharmaceutical companies and physicians should be made public 4.31±0.44

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receiving pharmaceutical gifts. This was also observed in the main influencing gifts were stationery items and
multiple other studies (4). CME event attendance (8).
Most doctors surveyed believed that accepting such Pharmaceutical companies often sponsor CME
gifts should be discouraged, as it may be unethical activities, and physicians in our study found the
to accept gifts that could alter behaviours and lead to information presented to them to be beneficial.
inappropriate prescriptions. In the literature, however, Regardless, most physicians moderately agreed that
many either think of these influencing attempts as CME events were a promotional gimmick that serves
benign or consider that their behaviour is immune to the publicity of the product in question. Educational
change (18). This belief is more prevalent among those activities run by pharmaceutical companies often lead to
who tend to receive gifts more frequently (9); in our an increase in prescription rates of a certain company’s
study, the majority of those who received gifts didn’t drug compared to its competitors (21).
necessarily agree with the potential of influencing. Information presented by PCRs, whether through
When asked about gift influencing as a personal drug detailing or conferences, could be misleading
issue, Lebanese physicians slightly disagreed; they did as it focuses on favourable points of interest while
not think they were personally influenced, even if they ignoring drawbacks like side effects (5). This is especially
believed their peers may be. The concept of conflict of problematic in developing countries, where many
interest is clearly overlooked by most physicians. physicians depend on PCRs to acquire information about
drugs (4).
One of the main ethics principles is beneficence, which
dictates that physicians must strive for the net benefit of While pharmaceutical companies perceive
promotional rewards as a boost to their sales, physicians
their patients. In the context of prescribing medications,
and society have huge ethical concerns about the
it means that the choice of the medication should be
acceptance of such gifts due to possible conflicts of
based solely on the best interest of the patient. This may
interest (1).
not be the case when a physician has an interest in or can
benefit from prescribing a certain medication. Evidence The main rationale behind rejecting a gift is the
shows that growing interactions between physicians belief that accepting it may imply an obligation towards
and pharmaceutical companies could lead to conscious the promoting company (3). Our findings reveal that
or subconscious conflicts of interest manifested as physicians did not feel pressured or guilty if they did not
lower prescription quality, more frequent prescription prescribe the promoted drug. However, questions remain
overall, and higher prescription costs and burdens on the about negative effects on patient care, financial profiles
patient (19). and public trust in healthcare workers (6). Participating
physicians said they believed their exchanges with
Humans tend to reciprocate received gifts, in our pharmaceutical companies should be public and
study this could translate into a change in behaviour transparent to improve their relationship with patients.
(9). Most Lebanese physicians surveyed believed that
Although the public and healthcare professionals
prescriptions could be affected by gifts; our data showed
believe that doctors could be allowed to accept certain
that the number of prescriptions was higher among
gifts, there is no agreed threshold value for such gifts
those who interacted with PCRs often versus those who
below which there would be no influence over physicians
did not. This phenomenon is also apparent across other
(22). Physicians in our study, particularly those who
populations of physicians (8).
usually accepted gifts, believed that such a defined value
Medication samples were the most common (94%) should exist; and it is known that the risk of behaviour
type of gift received from pharmaceutical companies. change is proportionally related to the value of a gift (9).
Many physicians consider samples to be a more ethical Self-reporting of physician-PCR interactions,
advertisement, as they are passed to the patient and along with the reception of gifts and drug samples,
would alleviate the costs of therapy (20). Not only does is decreasing; whether this reflects a decrease in
this action influence the prescribing doctor, who is more interactions or an avoidance of reporting is unclear. This
likely to recommend a non-familiar drug, but it also decrease, when occurring in a high-income country,
potentially affects the users of the promoted medication, could be related to regulations limiting these exchanges
as it is seen as an act of beneficence by the company (20). with pharmaceutical companies (23), e.g. requiring the
The debate continues over whether free drug samples submission of reports detailing the promotional gifts
are economically beneficial for patients, as cheaper, non- (24). Regulating these activities protects patients and
promoted alternatives could be available that could have ensures a transparent social image of healthcare workers
reduced the total cost of medications had no external in the eyes of the public (21).
influence occurred (19). In 2016, a code of ethics was established by the
Other promotional gifts presented during a PCR’s Lebanese Ministry of Public Health to regulate this field.
visit included stationery items (83.1%), books and journal It states:
subscriptions (80.9%), research funding (79.4%) and “Promotional items with modest or symbolic value can be
sponsored travel to conferences (73.3%), all of which align given to the doctors if they apply the following conditions: the
with findings in the literature (8). The studies found that gift should not be more than 10% of the monthly minimum wage,

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is useful to the professional’s practice, is related to the promoted veracity of the data. Moreover, the study did not dig
drug, and will add greater value for the patient care” (25). deeply into the prescription patterns and the medications
The majority of physicians, however, claimed not to most targeted by the pharmaceutical companies. The
have received a copy of this code (5) and our data showed broad nature of this topic made it difficult to address
that half of the respondents did not know what it implied within the scope of this study.
regarding promotional gifts. Although our study showed While the findings of this study contribute valuable
a correlation between awareness of the code of ethics and insight that resonates with existing literature, judicious
not accepting promotional gifts, it is clear that the mere interpretation should be exercised. Future studies
presence of ethical guidelines is not sufficient without could address these constraints for a more holistic
proper dissemination and implementation. To address understanding of the issue.
this gap and decrease the influence of pharmaceutical
companies on doctors’ prescription habits, healthcare
policymakers should develop and continuously update Conclusion
the comprehensive ethical guidelines. Although Lebanese physicians were aware of the effect
Physicians should be granted access to independent promotional activities could have on their prescription
drug information resources and should be educated about behaviours, many perceived interactions with pharma-
the potential biases. Financial disclosures, restrictions ceutical companies as an indispensable part of normal
on gifts and their monetary value, and prescription practice. While many promotional gifts are relevant to
monitoring systems that promote generic prescriptions patients and would enhance their care, a large proportion
are vital steps towards unbiased, evidence-based medical directly and solely benefit the physicians.
practices that prioritize patient welfare. Physicians need to be familiar with and abide by
the Code of Medical Ethics, which dictates the type
Limitations of promotional activities allowed within practice in
Lebanon. It would be sensible for medical institutions
While this study yields results congruent with the and medical schools to brief healthcare professionals
literature, we acknowledge certain limitations. The on common promotional activities and the possible
sampling frame obtained from LOP was 5936 email influence they may have on prescription practices.
addresses, which may not account for the entire medical
cohort in Lebanon. Governing bodies like the Lebanese Ministry of
Public Health and the Lebanese Order of Physicians are
The survey employed as the primary data collection
responsible for promoting and enforcing clear guidance
tool was in an online format, thereby potentially
on the ethics of prescriptions. Medical practice revolves
underrepresenting those who do not use email for
around patients’ well-being, which is a priority when
professional purposes.
commercialism and consumerism are infiltrating most
A reporting bias may exist among participants due to professions.
inherent sensitivities about self-disclosure within their
practice. Certain physicians may have been reserved Funding: None.
in their responses, thereby potentially influencing the Competing interests: None declared.

Croyances et pratiques des médecins au Liban concernant les cadeaux

promotionnels et leurs interactions avec les laboratoires pharmaceutiques
Résumé
Contexte : Les laboratoires pharmaceutiques investissent des sommes importantes dans l'offre de cadeaux
promotionnels afin d'influencer les prescriptions de médicaments par les médecins, mais les informations publiées
déterminant l'impact de ces pratiques sur les soins de santé sont limitées.
Objectif : La présente étude a pour objectif d'évaluer les croyances et les pratiques des médecins au Liban concernant
les cadeaux promotionnels et leurs interactions avec les représentants de laboratoires pharmaceutiques.
Méthodes : La présente étude transversale a été menée entre décembre 2019 et janvier 2020 au moyen d'un
questionnaire envoyé par courriel à 5936 médecins de différentes spécialités inscrits à l'Ordre des médecins libanais.
L'évaluation a été effectuée à l'aide d'un outil validé et l'analyse des données a été réalisée au moyen du logiciel SPSS
version 26.0.
Résultats : Sur les 268 répondants, 188 (70,4 %) ont indiqué que les médecins au Liban acceptaient des cadeaux de
la part de représentants de laboratoires pharmaceutiques. La plupart d'entre eux (31,7 %) communiquaient avec des
représentants de laboratoires plus d'une fois par semaine. Les échantillons de médicaments (251) et les fournitures
de bureau (222) étaient les cadeaux les plus fréquemment acceptés par les médecins qui ont admis en avoir reçu.
Dans l'ensemble, 225 répondants (84,9 %) estimaient que les ordonnances prescrites par les médecins au Liban
étaient influencées par les cadeaux reçus. Seuls 74 médecins (40,0 %) parmi ceux qui ont accepté des cadeaux de la

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Research article EMHJ – Vol. 30 No. 2 – 2024

part de laboratoires pharmaceutiques considéraient que cette pratique était contraire à l'éthique, et près de la moitié
ignoraient si le Code libanais de déontologie médicale leur permettait de les accepter.
Conclusion : Bien que les médecins au Liban soient conscients des conséquences que les cadeaux offerts par les
laboratoires pharmaceutiques pourraient avoir sur leurs habitudes de prescription, beaucoup d'entre eux continuent
de les accepter. La présente étude fournit des données probantes aux responsables de l'élaboration des politiques pour
la prise de décision concernant les directives éthiques régissant les interactions entre les médecins et les laboratoires
pharmaceutiques dans le pays.

‫معتقدات األطباء وممارساهتم يف لبنان فيام يتعلق باهلدايا الرتوجيية وتفاعالهتم مع رشكات األدوية‬
‫ حسني‬،‫ عبيدة اخلطيب‬،‫ دانة خزعل‬،‫ متارا فياض‬،‫ آالء قاسم محود‬،‫ مجيل سليامن‬،‫ نور صفاوي‬،‫ ريم فرحات‬،‫ جيدا حاسبيني‬،‫عصام الشعراين‬
‫برجاوي‬
‫اخلالصة‬
‫ إال أن املعلومات املنشورة عن هذه اهلدايا‬،‫ريا يف اهلدايا الرتوجيية للتأثري عىل وصف األطباء لألدوية‬
ً ‫استثامرا كب‬
ً ‫ تستثمر رشكات األدوية‬:‫اخللفية‬
.‫حمدودة لتقييم تأثريها عىل الرعاية الصحية‬
.‫ هدفت هذه الدراسة إىل تقييم معتقدات األطباء وممارساهتم يف لبنان فيام يتعلق باهلدايا الرتوجيية وتفاعالهتم مع مندويب رشكات األدوية‬:‫األهداف‬
‫ من خالل استبيان قائم عىل‬2020 ‫ كانون الثاين‬/‫ ويناير‬2019 ‫ كانون األول‬/‫ ُأجريت هذه الدراسة املقطعية يف املدة ما بني ديسمرب‬:‫طرق البحث‬
‫وح ِّللت البيانات‬
ُ ،‫جري التقييم بأداة متحقق منها‬
َ ‫وأ‬ُ .‫سجلني يف نقابة أطباء لبنان‬ َ ‫الربيد اإللكرتوين ُأ‬
َّ ‫ ُم‬،‫ طبي ًبا من خمتلف التخصصات‬5936 ‫رسل إىل‬
.SPSS ‫ من برنامج‬26,0 ‫باإلصدار‬
‫) بأن األطباء يف لبنان قبلوا اهلدايا من مندويب رشكات‬%70,4( ‫ منهم‬188 ‫ أفاد‬،‫ طبي ًبا‬268 ‫ من بني املشاركني يف االستبيان البالغ عددهم‬:‫النتائج‬
)%94,0 ‫؛‬251 = ‫ وكانت عينات األدوية (العدد‬.‫) مع مندويب الرشكات أكثر من مرة يف األسبوع‬%31,7( ‫ وتفاعل معظم األطباء‬.‫األدوية‬
ً
225 ‫ رأى‬،‫وإمجااًل‬ .‫شيوعا التي حصل عليها األطباء ممن اعرتفوا بقبوهلم للهدايا‬
ً ‫) أكثر اهلدايا‬%83,1 ‫؛‬222 = ‫واألدوات القرطاسية (العدد‬
ً
‫) ممن قبلوا هدايا من رشكات األدوية‬%40,0( ‫ فقط‬74 ‫ ورأى‬.‫) أن الوصفات الطبية التي قدمها األطباء يف لبنان قد تأثرت باهلدايا‬%84,9( ‫مشاركا‬
.‫ ونحو نصف هؤالء ال يعرفون هل تسمح مدونة األخالقيات الطبية اللبنانية هلم بقبول هدايا من رشكات األدوية أم ال‬،‫أنه أمر غري أخالقي‬
ٌ ‫ فام زال‬،‫ رغم أن األطباء يف لبنان كانوا عىل علم بتأثري قبول اهلدايا من رشكات األدوية عىل سلوكياهتم يف كتابة الوصفات الطبية‬:‫االستنتاجات‬
‫كثري‬
‫ وتقدم هذه الدراسة دالئل لراسمي السياسات من أجل اختاذ قرارات تتعلق باإلرشادات األخالقية بشأن التفاعالت بني األطباء‬.‫منهم يقبل اهلدايا‬
.‫ورشكات األدوية يف لبنان‬

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