Muhammad Naveed Noor’s research while affiliated with Aga Khan University and other places

The health and wellbeing of queer Muslims, a group positioned at the intersection of multiple marginalised identities, remains underexplored in academic literature. This scoping literature review critically analyses existing research on queer Muslim health using the 4M framework (Mega, Macro, Meso, Micro) to identify structural and individual determinants impacting health outcomes. The study highlights the profound influence of intersecting factors such as race, ethnicity, gender, sexuality, geographic location, and socioeconomic status on healthcare access and health outcomes. Findings reveal that dominant epistemological assumptions about queerness and Islam perpetuate stigma, discrimination, and minority stress, leading to adverse health outcomes. Key barriers include inadequate funding, homonormative healthcare policies, and exclusionary cultural expectations within healthcare settings. Conversely, supportive familial, peer, and religious networks, along with access to digital resources, are identified as facilitators of better health outcomes. The review calls for culturally competent, strength-based models of care and emphasises the need for future research to address the diverse health experiences of queer Muslims across different regions and identities.

Introduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors’ engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan. Methods We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars. Results We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors’ age, sex and clinic district, there was no evidence of the intervention’s impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192). Conclusions This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere.

Objective: To investigate private General Practitioners’ (GPs) interest in continuous professional development (CPD), with a focus on ethical practices.Methods: A mixed method study design conducted a cross-sectional survey of registered private GPs (n=419) in Karachi was conducted in the year 2022 on their professional and ethical practices with perspectives on engagement in training in the year 2022. Qualitative interviews were conducted with 28 GPs to get a deeper understanding of their views on professional development.Results: The median age of participants was 55 years (IQR 48-63 years) and 361 (86.2%) were males. The median number of years of professional experience was 31.0 years (IQR 24-37 years). It was observed that 116 (27.6%) of GPs saw more than 50 patients per day, and 377 (90%) met with pharmaceutical sales representative (PSR) regularly. Reported awareness of guidelines on ethical practices was 325 (77.6.0%), and willingness to sign a pledge committing to a code of ethics and to be part of a professional network of ethical doctors was high, 389 (~93.0%). However, both qualitative and quantitative data indicated that GPs had limited time for training, despite the interestin filling gaps in knowledge about ethical practice.Conclusion: Most GPs were willing to engage in CPD activities with a focus on ethics. Many GPs met regularly with PSRs, and CPD may reduce the pharmaceutical industry influence on their prescribing practices.Keywords: General Practitioner, Ethical practices, Mixed methods

Objective: To examine the perceived impact of incentive-linked prescribing (ILP) on the everyday lives of patients in Pakistan.Methods: Adopting a qualitative approach, in-depth interviews were conducted with 26 patients in Karachi. A convenient sampling method was used to recruit patients from different pharmacies located in all six districts of Karachi namely East, West, South, Central, Korangi, and Malir. The interviews were thematically analyzed using the software NVivo Version.12.Results: ILP was perceived to affect patients in three interrelated ways: financial difficulty, mental distress, and difficulty in adhering to medical treatments. Most of the participants reported experiencing financial difficulties and were unable to afford everyday household needs. ILP was believed to make physicians prescribe expensive brands, which in turn, added to patients’ financial difficulties. Due to expensive medications, some patients stopped seeking healthcare from physicians and instead relied on home remedies. ILP-related financial burden on patients was also perceived to be a contributor to their mental distress.Conclusion: Patients are increasingly becoming aware of physicians’ engagement in ILP, and believe it harms them in different ways. It has important implications for physicians’ reputations in society. Physicians must adhere to the principles of patient-centred care by avoiding ILP.Keywords: Incentives, physicians, patients, pharmaceutical companies, healthcare, patient-centered care, Pakistan

Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients’ health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and the general public often have far less awareness about the practice of pharmaceutical incentivisation of physicians. We conducted a scoping review to explore what existing research says about HCCs’ perceptions of the financial relationship between physicians and pharmaceutical companies. To conduct this scoping review, we followed Arksey and O’Malley’s five-stage framework: identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results. We also used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ extension for scoping reviews (PRISMA-ScR), as a guide to organise the information in this review. Quantitative and qualitative studies with patients and the general public, published in the English language were identified through searches of Scopus, Medline (OVID), EMBASE (OVID), and Google Scholar. Three themes emerged through the analysis of the 13 eligible studies: understanding of incentivisation, perceptions of hazards linked to ILP, and HCCs’ suggestions to address it. We found documentation that HCCs exhibited a range of knowledge from good to insufficient about the pharmaceutical incentivisation of physicians. HCCs perceived several hazards linked to ILP such as a lack of trust in physicians and the healthcare system, the prescribing of unnecessary medications, and the negative effect on physicians’ reputations in society. In addition to strong regulatory controls, it is critical that physicians self-regulate their behaviour, and publicly disclose if they have any financial ties with pharmaceutical companies. Doing so can contribute to trust between patients and physicians, an important part of patient-focused care and a contributor to user confidence in the wider health system.

Sexually diverse Muslim men (SDMM) are seen to present later and with more advanced symptoms of HIV and other sexually transmitted infections (STIs). The limited access to sexual healthcare services is attributed to the stigma associated with their multiple intersecting identities. We conducted a scoping review to synthesise research on barriers impeding SDMM’s access to sexual health care. We used Arksey and O’Malley’s five-stage framework as the methodology for the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ extension for scoping reviews, was used as a guide for the presentation of the results. Searches conducted in EBSCOhost, Scopus, MEDLINE, Embase, CINAHL, Global Health, and Google Scholar yielded 1382 results, of which 18 studies were deemed eligible for this review. Bronfenbrenner’s socioecological model was employed as a framework to analyse the studies. Through analysing the eligible studies, we identified factors operating at three different levels that can impede SDMM’s access to sexual health care. Limited awareness and low-perceived risk of HIV/STIs, coupled with the fear of sexual identity disclosure might act as individual-level barriers to sexually diverse Muslim men’s access to sexual health care. The experiences of discrimination within clinical settings were presented as a healthcare system-related issue discouraging SDMM from revisiting those services. Heteronormative and religious ideologies, homophobic government programs, and poverty might manifest in the more intimate domains of healthcare delivery, creating hostile spaces for SDMM. Intensive research and advocacy efforts are required to improve SDMM’s access to sexual health care, which can reduce their risk of HIV/STIs.

Background: Despite known adverse impacts on patients and health systems, ‘incentive-linked prescribing’, which describes the prescribing of medicines that result in personal benefits for the prescriber, remains a widespread and hidden impediment to quality of healthcare. We investigated factors perpetuating incentive-linked prescribing among primary care physicians in for-profit practices (referred to as private doctors), using Pakistan as a case study. Methods: Our mixed-methods study synthesised insights from a survey of 419 systematically samples private doctors and 68 semi-structured interviews with private doctors (n=28), pharmaceutical sales representatives (n=12), and provincial and national policy actors (n=28). For the survey, we built a verified database of all registered private doctors within Karachi, Pakistan’s most populous city, administered an electronic questionnaire in-person and descriptively analysed the data. Semi-structured interviews incorporated a vignette-based exercise and data was analysed using an interpretive approach. Results: Our survey showed that 90% of private doctors met pharmaceutical sales representatives weekly. Three interlinked factors perpetuating incentive-linked prescribing we identified were: gaps in understanding of conflicts of interest and loss of values among doctors; financial pressures on doctors operating in a (largely) privately financed health-system, exacerbated by competition with unqualified healthcare providers; and aggressive incentivisation by pharmaceutical companies, linked to low political will to regulate and an over-saturated pharmaceutical market. Conclusion: Regular interactions between pharmaceutical companies and private doctors are normalised in our study setting, and progress on regulating these is hindered by the substantial role of incentive-linked prescribing in the financial success of physicians and the pharmaceutical industry employees. A first step towards addressing the entrenchment of incentive-linked prescribing may be to reduce opposition to restrictions on incentivisation of physicians from stakeholders within the pharmaceutical industry, physicians themselves, and policymakers concerned about curtailing growth of the pharmaceutical industry.