Healthy Skepticism Library item: 18758

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

Drug promotion a cautionary tale
Australian Doctor 2010 Oct 20
http://www.australiandoctor.com.au/articles/1a/0c06d21a.asp

Full text:

THERE is no conclusive evidence that the quality of prescribing by doctors exposed to drug company promotion is either improved or undermined, a systematic review has found.

Researchers from Australia, Canada and Malaysia collated the results of 58 studies on the effects of drug rep visits, journal advertisements, attendance at pharmaceutical-sponsored meetings, mailed information, prescribing software and participation in sponsored clinical trials.

It said there was some evidence of “increased costs and decreased quality of prescribing” resulting from the marketing.

But it stressed the limitations in the studies – most of which were observational and none directly assessing patient clinical outcomes – meant they were “unable to reach any definitive conclusions about the degree to which information from pharmaceutical companies increases, decreases, or has no effect on the frequency, cost, or quality of prescribing”.

Of those studies that examined “prescribing quality outcomes”, the researchers said five found “associations” between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower- and higher-quality prescribing.

The systematic review, published in PLoS Medicine, said: “Any conclusions about harm or benefit for patients are speculative because none of the studies that we found examined clinical outcomes. One clear conclusion from this review is that we did not find evidence of net improvements in prescribing associated with exposure to information from pharmaceutical companies.”

It added: “In the absence of evidence of net improvement in prescribing from exposure to promotional information, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies unless evidence of net benefit emerges.”

Lead author Dr Geoff Spurling, senior lecturer in general practice at the University of Queensland, told Australian Doctor: “I think if you considered pharmaceutical information as a drug and looked at what this review has found you might not want doctors to take it. Drug companies themselves say that their information is beneficial and educational and this review does not support that claim.

“My message to doctors is that they need to stop assuming they are invulnerable to promotion. My message to drug companies is that they should stick to what they do best and that is converting basic scientific information into useful and beneficial therapeutics.”

But Dr Brendan Shaw, CEO of Medicines Australia, which represents the main pharmaceutical companies, said: “Doctors will make their own judgements as to whether they wish to engage with pharmaceutical company representatives. The fact is that no one knows more about how medicines work than the companies who make them. Every year in Australia thousands of doctors vote with their feet by attending company-sponsored medical education events because they derive genuine educational benefit from them.”

He added: “Manufacturers have a legitimate commercial right to promote their products to doctors, so long as the information provided is current, accurate, balanced and consistent with the product information, and that the promotion is undertaken in a manner that is ethical and adherent to the Medicines Australia Code of Conduct.”

PLoS October 2010; Volume 7, Issue 10.