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Healthy Skepticism Library item: 41

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: Journal Article

Jones MI, Greenfield SM, Bradley CP.
Prescribing new drugs: qualitative study of influences on consultants and general practitioners
BMJ 2001; 323:378-384
http://bmj.bmjjournals.com/cgi/content/full/323/7309/378

Keywords:
*analytic survey United Kingdom sales representatives primary care doctors source of information quality of prescribing internists (physicians) psychiatrists & psychiatry INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE PROMOTION AS A SOURCE OF INFORMATION: DOCTORS


Notes:

Objective
To explore consultants’ and general practitioners’ perceptions of the factors that influence their decisions to introduce new drugs into their clinical practice.

Design
Qualitative study using semistructured interviews. Monitoring of hospital and general practice prescribing data for eight new drugs.
Setting
Teaching hospital and nearby general hospital plus general practices in Birmingham.
Participants
38 consultants and 56 general practitioners who regularly referred to the teaching hospital.

Main outcome measures
Reasons for prescribing a new drug; sources of information used for new drugs; extent of contact between consultants and general practitioners; and amount of study drugs used in hospitals and by general practitioners.

Results
Consultants usually prescribed new drugs only in their specialty, used few new drugs, and used scientific evidence to inform their decisions. General practitioners generally prescribed more new drugs and for a wider range of conditions, but their approach varied considerably both between general and between drugs for the same general practitioner. Drug company representatives were an important source of information for general practitioners. Prescribing data were consistent with statements made by respondents.

Conclusions
The factors influencing the introduction of new drugs, particularly in primary care, are more multiple and complex than suggested by early theories of drug innovation. Early experience of using a new drug seems to strongly influence future use.

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909