Prescription ethics in a low-middle income country: Thematic analysis of research from Pakistan

The ethics of physician prescriptions is a matter of global concern. While commonalities exist in reasons for unethical prescribing practices such as physician incentivization by pharmaceutical companies, the underlying social determinants may be different across countries and socioeconomic strata. This scoping review has collected themes from publications around prescription ethics from Pakistan. Four major themes were identified: 1) Impact - including physical and financial harm to patients, deficit in trust and development of antibiotic resistance, 2) Causes - including personal financial needs, peer pressure, inadequacy of education in ethics and professionalism, lack of evidence for policy-making, and weak regulatory framework, 3) Type - includes unethical practices like excessive, inappropriate/unnecessary, expensive, nonevidence- based, and off-label prescriptions, and prescription of controlled drugs to addicts, and 4) Solution - proposed strategies to curb unethical prescribing practices included education of community and undergraduates, trainees and practicing physicians, improvement in policies/laws on drug dispensation/prescriptions, their enforcement and accountability, as well as making health care accessible. In summary, this review identifies various social determinants of prescription ethics in the context of Pakistan, a low-middle income country, and highlights locally applicable measures to prevent unethical prescribing practices.