Ray Moynihan: No to marketing

During training, I was told, when you’re out to dinner with a doctor, “The physician is eating with a friend. You are eating with a client” — former drug rep

A NEW alliance called No Advertising Please has just kicked off in Australia, and in the lead-up more than 100 doctors from across the country have already pledged to ban pharmaceutical representatives from their surgeries for the next 12 months.

No Advertising Please (NAP) is the initiative of Brisbane GP Dr Justin Coleman, who has won support for the new group from some influential Australian academics and educators, and strong endorsement from the Consumers Health Forum.

Like others supporting the campaign, Coleman is motivated by evidence showing that doctors who expose themselves to marketing tend to prescribe more costly drugs and less appropriately, and by the growing availability of more independent sources of drug information like NPS MedicineWise.

“We want to discourage routine acceptance of promotion”, says Coleman, stressing there is no aim to demonise pharmaceutical companies, which provide many life-improving medicines.

Industry reacted strongly to the new NAP campaign late last week, with comments implying doctors who don’t see reps may be vulnerable to law suits. In a media release Medicines Australia chair Dr Martin Cross said “the idea that you can ignore information from a pharmaceutical company that has conducted extensive research and development to help treat disease is laughable at best and negligent at worst”.

Colleagues at Bond University’s Centre for Research in Evidence-Based Practice stopped seeing drug reps long ago, and they’ve welcomed the emergence of NAP. “We’re not anti-drug and this isn’t anti-pharmaceutical industry”, says Professor Chris Del Mar. “On the contrary, drugs are the mainstay of the different forms of treatment we deliver in primary care. We’re just bothered by the advertising and in particular the advertising that goes through drug reps.”

Professor Paul Glasziou argues there’s a great “opportunity cost” when doctors spend precious medical education time with reps, instead of seeking independent evidence, or meeting in journal clubs with colleagues.

“If I was a patient I’d want to see a doctor who kept up to date by looking at the best evidence, not necessarily by seeing drug reps. When I go to a doctor I want the best treatment, not the latest treatment.”

The Consumers Health Forum also welcomes the initiative as an important sign doctors’ prescribing decisions might be based more on the best independent evidence and less on marketing spin. “It can only boost the level of trust patients place in their doctors to see a NAP poster in their waiting rooms”, says CHF chief executive officer Adam Stankevicius.

For many years, drug reps have provided sustenance to prescribing doctors, offering food, flattery and friendship, along with what appears to be the opportunity to keep up with the latest information. But scandals over misleading promotion where benefits have been hyped or harms played down — think Vioxx, Tamiflu or Avandia — means more doctors are seeking to satisfy their information needs elsewhere.

A  growing number of whistleblowers have also raised questions about marketing techniques used by sales representatives — former drug reps in Australia and elsewhere who have revealed how seduction happens, how “key opinion leaders” are groomed and used, and how even sceptical doctors are won over with sophisticated sales strategies.

At the same time a new global push for transparency has culminated in the US Sunshine Act, which will require every payment to every doctor to be made available, with names and numbers on a searchable website.

Australia is dragging its heels, but such transparency reform here is surely inevitable. It was only a couple of years ago that a survey conducted for GlaxoSmithKline found that 50% of Australians consider drug company payments to doctors to be bribes.

For drug companies these are tricky times. One response to changing community expectations has been the rise of the role of “medical science liaison” folk within companies — better trained and ostensibly more separated from the commercial arm, but nevertheless employees who help deliver shareholders a return on investment.

Justin Coleman is hoping that specialists as well as GPs will sign the pledge not to see reps. “After all that work and study, specialists rightly have a position of influence”, says Coleman, “but that privileged position brings responsibility, as the decisions they make about a medication has flow-on effects for GPs and their patients. It’s important those decisions are based strongly on evidence rather than marketing.”

Whether or not No Advertising Please takes off in a big way, with a budget about 1 billionth of the annual spend on drug marketing in Australia, it’s certainly likely to be cost-effective!
 

Ray Moynihan is a Senior Research Fellow, Bond University

Competing interest: Ray Moynihan is a long-time author and writer on medical matters and has helped launch the new alliance, No Advertising Please.