Healthy Skepticism Library item: 4479

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

Mansfield PR.
Gifts must go
Australian Doctor Weekly 2003 Aug 21

Full text:

EDITOR Dr Hing Kwok Mak’s letter (‘Drug influences’, 18 July) raises many good questions.

1. Should GPs’ decisions about gifts from drug companies be based on commonsense or evidence?

In the 17th century it was commonsense that the sun revolved around the earth. Galileo was attacked for saying that the evidence showed otherwise. Since then physicists have found they obtain better results and thus higher status and incomes from rejecting commonsense when it conflicts with the evidence from careful observation and experiment.

Patients and GPs will benefit if we read with open minds the new evidence against gifts.

2. Can GPs be confident about our ability to use scepticism and critical appraisal to protect ourselves from being misled by drug promotion?

GPs’ levels of scepticism and critical appraisal skills vary. Healthy Skepticism’s expertise at critical appraisal of drug promotion is recognised by many organisations including the WHO.

However, despite 20 years’ work with Healthy Skepticism(formerly MaLAM), I am not confident that I can resist being misled for several reasons including: a) much promotion works below the level of conscious awareness; and b) omission of key information is often difficult to detect.

Psychological evidence shows that attempts to improve a person’s ability to avoid being misled are likely to fail unless they come to understand that they are more vulnerable than they realised.

3. Do small gifts adversely influence prescribing?

No one is claiming that we knowingly betray our patients for a brand-reminder pen. The evidence shows that gifts create reciprocal obligations that can influence us without our being aware of it.

Accepting gifts is a risk factor for: a) genuinely believing that drug promotion does more good than harm; b) relying more on drug company information; and c) genuinely believing that expensive drugs are superior despite many of them being inferior.

4. Does refusing gifts involve “righteous” self-sacrifice?

Gifts contribute to wasting at least $1 billion a year on suboptimal prescribing that could be used to give us better incomes. Judges get dismissed if they take gifts from people with interests in their judgments.

Dr Peter R Mansfield,GP and director

Healthy Skepticism, Willunga, SA