Healthy Skepticism Library item: 18852

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: news

Spurling G
Time to put education to tender
MJA InSight 2010 Nov 8
http://www.mjainsight.com.au/view?post=Geoffrey+Spurling:+Time+to+put+education+to+tender&post_id=1520

Full text:

IT is time the medical profession stopped relying so heavily on the
pharmaceutical industry for its ongoing education about medications.

I have been involved in recent research that should convince
policymakers the time has come to trial a system where education and
promotion of medications to physicians is put out to competitive
tender with measurable outcomes such as adherence to prescribing
guidelines.

The promotion of pharmaceuticals to doctors is a huge industry with US
$57 billion spent on promotion in 2004 in the US alone.

Australian data suggest that pharmaceutical companies spend more than
$10 000 for each Australian GP that sales representatives visit each
year.

The industry claims this promotion is educational and beneficial to
prescribers. Many doctors deny that it influences their prescribing.

The recent research I was involved with was a systematic review of all
the medical literature in the past 40+ years.

We started with more than 7000 articles and finally included 58 which
answered the research question regarding the impact of pharmaceutical
information on prescribing.

The clear conclusion from this review is that the medical literature
does not support claims of benefits for doctors in using
pharmaceutical promotion.

The other clear conclusion is that many studies found associations
between promotion and increased frequency of prescribing, suggesting
that doctors are influenced by pharmaceutical promotion at least some
of the time.

Our review does not exclude the possibility that pharmaceutical
company promotion benefits patients in certain situations.

One study found that residents attending a sponsored education session
were more likely to prescribe the sponsoring company’s medication when
it was appropriate but also when it was inappropriate.

Other studies looking specifically at quality of prescribing as an
outcome found that doctors seeing sales representatives were less
likely to adhere to prescribing guidelines and less likely to
prescribe rationally.

One study found that physicians with high prescribing costs were more
than three times more likely to see pharmaceutical representatives
once a week and were more likely to read promotional mail or journal
advertisements from pharmaceutical companies than physicians with low
prescribing costs.

Our study concluded that “The findings support the case for reforms to
reduce negative influence to prescribing from pharmaceutical promotion.”

More prescribing of pharmaceutical products does not always equal
better health, as any practitioner who prescribed Vioxx would know.

We argue that promotion should be regulated and doctors should be
provided with more resources to aid their therapeutic decision making.

A tender system of offering education could be open to pharmaceutical
companies but they might be competing with universities or specialist
colleges.

This would give pharmaceutical companies the incentive to promote
their products in a way that ensured physicians prescribed rationally
in addition to the incentive of providing a return on investment to
their shareholders.

I would like to see research evaluating this type of tender, similar
to what occurs with competitive research grants and other tendering
processes.

There also needs to be an emphasis on educating medical students and
junior doctors about the value of independent sources of information.

Remember that, as doctors, we are not invulnerable to promotion from
pharmaceutical companies and that the sales representatives are there
for the company’s shareholders as much as for us.

We would save time by using independent sources of information and our
patients are likely to support reforms that ensure this occurs.