The drug industry and medical practice—the case of menopausal hormone therapy in Estonia

After the dissolution of the Soviet Union, Estonia quickly adopted a market economy. In medicine this has included the uptake of western-style health care and drug promotion aimed at practising physicians. Using post-menopausal hormone therapy (HT) as an example, we studied the consequences of this natural experiment on prescribing and on physicians’ opinions of HT and drug promotion. Data were obtained from a cross-sectional questionnaire survey sent to gynaecologists and family practitioners (FPs) in 2000 compared to an earlier Finnish survey, and from drug sales figures (based on defined daily doses), local medical journals and observations. The survey focussed on physicians’ opinions of HT, HT information and HT education, and was sent to a random sample of 500 physicians, of whom 68% responded. The sales of HT drugs in the 1990s in Estonia were much lower than in Finland, but rapidly rose during that decade. Physicians considered drug advertising to be a factor contributing to the increased HT use. Most gynaecologists but fewer FPs reported that they had had enough continuing education on menopause and HT. For 39% of the gynaecologists and 20% of the FPs, (part of) the costs to attend their last education activity was paid by a drug firm. Respondents who wished for further education considered drug firms to be potential organisers. Gynaecologists had had more communication on HT with the drug industry, and their attitudes towards HT were more positive than those of FPs. Fears about cancer in the 1980s were not found in 2000. The study suggests that the drug industry contributed to the change in physicians’ views of HT.