Sales and financial gains have been the main determinants of policies and actions of pharmaceutical companies (Grouse, 2008). For this reason pharmaceutical companies have allocated a significant budget reaching up to 8 billion dollars per year, in the US alone, for marketing their products (Grouse, 2008). This money has been offered to physicians and medical professional organizations (MPOs) as grants for research and for promoting the medical education system in the form of symposiums with well-known experts, direct monetary benefits, and funding travels for key opinion leaders (KOLs) (Grouse, 2008). Such a substantial investment in marketing, targeting health professionals, is certainly expected to impact treatment decisions and drug prescription patterns (Kamal et al., 2015). Subsequently, worldwide public concerns arose about the possibility of conflict of interest since physicians would tend to prescribe expensive, sometimes unnecessary drugs, to promote the products of particular pharmaceutical companies (Grouse, 2008). Furthermore, while there appears to be more or less some evidence for the interactions between pharmaceutical companies and pharmacists in the form of gift-giving (Zaki, 2014); these interactions appear to be less commonly investigated (Kamal et al.2015). Finally, although an ethical code of conduct can be found in a number of multinational pharmaceutical companies, appropriate legislative regulation is still absent in many low and middle income countries (Kamal et al., 2015). As a consequence, the main duty of health professionals, such as physicians and pharmacists in maintaining the health and wellbeing of patients, is being put in jeopardy through their interactions with pharmaceutical companies (Grouse, 2008).

In Lebanon, the nature of interactions between pharmaceutical companies, physicians, and pharmacies is still vague. Also, its influence on physician and pharmacist’s medical practices are still ambiguous. Furthermore, the extent of the interaction between pharmaceutical company representatives and pharmacists, and its potential use for monitoring physician prescriptions has not been explored yet; though research in the states has shown the importance of this role played by pharmacies (Fugh-Berman, 2008). Hence, the purpose of this study is to explore qualitatively the nature, intensity, and effect of the interactions between pharmaceutical companies, physicians, and pharmacists on drug prescription and dispensing practices in Lebanon.

Our sample frame will consist of the three following groups:

1)    Physicians practicing in clinics and hospitals in Lebanon, including AUBMC

2)    Pharmacists or pharmacy staff who handle prescriptions in an out-patient setting.

3)    Pharmaceutical company representative from different pharmaceutical companies.

Investigators will approach physicians, pharmacists, and pharmaceutical company representatives. When relevant, we will get administrative approval from their institutions. We will recruit participants from five different areas capturing urban, suburban and rural areas in Lebanon. Participants will vary by age, gender, years in practice, specialty and country of training (purposive sampling). First interviewees will be identified by key contact known by the investigators (known sponsor approach) and will be invited. If they show potential interest and are eligible to participate in the research, they will be asked to consent to participate. Then, they will be contacted to agree on a date and time for the interview. The interview is expected to last approximately 30 minutes, and will likely be conducted in a suitable setting to ensure privacy (as agreed upon by interviewers and interviewees) before the due date. Participants will be sent a reminder of the interview time.