Healthy Skepticism Library item: 20534

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Magazine

Ragg M
Doctored facts for GPs
The Bulletin 1993 Mar 3016-17

Abstract:

Drug companies are a major source of information for GPs. Mark Ragg considers their reliability.

Full text:

The majority of popular prescription drugs are fewer than 15 years old, yet most doctors graduated more than 15 years ago. Where do GPs learn about the medicines they prescribe?

According to a 1990 survey by Quadrant Research Services, general practitioners spend about 80 minutes each week reading medical newspaper and journals, 36 minutes in discussion with colleagues, 22 minutes with drug company representatives and 14 minutes reading drug company mailings. They attend seven meetings a year – mostly organised by drug companies.

Awareness: The survey found the average GP sees two drug reps a week, meets the average rep three times a year and spends 11 minutes with each. Only 7% of doctors don’t see drug reps. This means 93% of GPs get a small pile of pens, pads, lights, calculators and samples, all carrying a product name and creating awareness of a particular product.

But the main source of doctors’ knowledge is the medical press which consists of many more publications than is usual for one industry and is overwhelmingly funded by drug company advertising. At least half-a-dozen profitable industry publications exist – plus a few unprofitable ones.

There are mainstream academic journals (Medical Journals of Australia), medical newspapers (Australian Doctor and Medical Observer), continuing education journals (Australian Family Physician, Current Therapeutics and Modern Medicine), political magazines (Australian Medicine), drug compendiums (MIMS) and a host of more specialised publications.

The Medical Journal of Australia and Australian Medicine are published by the Australian Medical Association (AMA), while the rest are owned independently – most internationally.

Most of these publications are sent free to all GPs. Also on the free list are cardiologists, respiratory specialists, rheumatologists and gastroenterologists. Industry sources say that the drugs prescribed by these four specialist groups account for more than 80% of drug company advertising.

According to a Quadrant survey for the Medical Publishers Association of Australia, most titles have a readership of between 70% and 80%. The medical newspapers do slightly better than the continuing education journals and the AMA’s publications lag badly.

Tendency: A telling trend is that doctors who prescribe more than 40 products a day (and that is a lot of drugs – almost certainly more than one script for each patient) are more likely to read the medical media than GPs who prescribe little. They also tend to read the publications in more detail. What came first? The tendency to seek a drug cure for many ills, including many that are undoubtedly social in origin, or the constant barrage of glossy advertising?

A report by Sydney marketing company Lenehan Lynton Bloom Blaxland notes that “advertising works better… in a sympathetic environment”. All these publications are basically sympathetic to their readers (the doctors) and advertisers (the drug companies). Critical articles are carried, but the overall flavour is different from publications such as the federal government’s Australian Prescriber, which warns of dangers with drugs and carries no advertising.

The importance placed on advertising by the drug companies is apparent by the careful readership profiles they assemble. All research breaks doctors down by age, sex, number of people in the practice, year of graduation and number of scripts written a day. Advertisers like publications that reach doctors who write scripts readily. They are the ones who invited to the dinners and symposia.

Supplement: An important promotional tool is the medical journal supplement. Supplements do not just happen – they are basically advertising features that carry scientific material and are usually sponsored by a drug company, which has considerable say over what appears inside. Usually, articles for these publication are not subject to the same peer review process as the body of the journal. Even though the cost of this form of marketing is high, drug companies consider it worthwhile.

A drug company may wish to make some claim about its product in its advertisements to doctors. It can only make those claims if material to support the claim has been published in a peer reviewed medical journal. Sometimes drug companies would like to make claims about their product but cannot find references to support them from the literature.

In this case they may sponsor a supplement which will carry research of such a minor nature it would not normally make it into the main part of a reputable journal. Editors, while saying everything that appears in the supplement is true, admit a lower standard of scientific importance applies.

There is nothing at all illegal in this but it does put a question mark over the scientific validity of statements made in advertisements.