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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.
Dr Geoffrey Spurling is a senior lecturer in the Discipline of General Practice at the University of Queensland and a general practitioner at the Inala Indigenous Health Service.
Posted 8 November 2010