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An evidence-based call to get pharma out of medical education

A team of researchers from Australia, Canada and Malaysia has published a systematic review investigating the impact of pharmaceutical promotions in the online journal PLoS Medicine.

The editor’s summary of the review concludes: “The findings support the case for reforms to reduce negative influence to prescribing from pharmaceutical promotion.”

Thanks to the lead author, Dr Geoffrey Spurling, from the University of Queensland, for providing this report for Croakey readers.

Geoffrey Spurling writes:

Doctors advised to avoid pharmaceutical promotion.

This was our conclusion following the first review to exhaustively examine all the available literature on the information from drug companies to doctors. Leading an international team with expertise in this area, I found no benefit for doctors and their prescribing after seeing pharmaceutical representatives, attending sponsored drug meetings and reading journal advertisements among other types of promotion.

The findings are based on our search of the literature involving over 7000 articles with 58 finally being included in the review.

Contrary to pharmaceutical company claims that their promotional activities are educational and beneficial, we found that in almost all cases, drug company information was associated with reduced prescribing quality and increased prescribing costs or no change.

One study found that doctors using more pharmaceutical company information had less rational prescribing while another found that increasing numbers of pharmaceutical company representative visits resulted in less prescribing guideline adherence by doctors.

Another study found that physicians with low prescribing costs were less likely to see pharmaceutical representatives regularly and were more likely to have rarely or never read promotional mail or journal advertisements from pharmaceutical companies than physicians with high prescribing costs

No studies looking at pharmaceutical company information found that promotion reduced prescribing frequency and many found an association with increased numbers of prescriptions contrary to claims by doctors that they are not influenced by pharmaceutical company information.

One study found that pharmaceutical sales representative visits were associated with greater increases in market share for new drugs than was positive scientific information about these drugs. The same study also found that journal advertisements were associated with increased market share than positive scientific information in these journals.

The major limitation of this study is that most of the studies are observational and it is not possible to draw definitive conclusions about the effects of drug company information on doctors. It may be that doctors who do a lot of prescribing attract more promotion from pharmaceutical companies. This study does not exclude the possibility that there may also be situations where prescribing is improved.

Pharmaceutical companies appear to be satisfied that their promotional activities are influencing doctors, increasing market share and prescribing. In 2004, pharmaceutical companies spent $57 billion dollars on promotion in the United States and we think it is unlikely that they would do this if it was not in the interest of their shareholders.

The policy implications of these findings are clear.

We call on governments, serious about evidence-based policy, to legislate to form an independent pool of educational funds for doctors. Financial incentives should be provided to encourage pharmaceutical company contribution to this fund which would encourage the rational use of their products.

We also call on policy makers to set up an independent body to regulate promotion and ask government to invest heavily in independent sources of information for doctors. This will allow pharmaceutical companies to do what they do best; concentrate on converting basic scientific discoveries into therapeutic products.

After conducting this review, it is clear to me that doctors need to accept that they are influenced by pharmaceutical promotion at least some of the time.

We think that peak doctor bodies need to implement the review’s recommendation to avoid information from pharmaceutical companies unless evidence of benefit emerges. These reforms are likely to be well received by a public keen to get the best evidence-based health care from both doctors and policy-makers.

Comments 5

  1. lindsayb says:

    “and ask government to invest heavily in independent sources of information for doctors”.
    The government has spent the last 2 decades de-funding independent university research, and pushing research onto grant and industry money. They cynic in me suspects that the pharma industry is very happy with the current situation, as money (or the lack thereof) is a great way to get researchers to ask the “right questions” rather than the hard questions. Good luck with getting this changed.

  2. ron batagol says:

    I’ve written extensively at various times about the issue of Drug Companies taking over “continuing education “ of health professionals
    Don’t get me wrong. Drug company personnel do perform an invaluable educative service in the areas of complex and specialised products eg. oncology services, and specialised injectable products, or products with a special regimen. They can be of great assistance in advising on techniques of administration, methods of giving etc.
    However, when we take the next step and venture out to the purely professionally educative role, then I think we go beyond the scope of the drug company reps.
    Sure, they will have a whole range of booklets, plus extracts from review articles and papers that support the superior efficacy and safety of their product, and these may be a useful starting point for us to read, for a newly-introduced drug product.
    But, that’s quite different to Drug Companies organising expensive “nosh-ups” for doctors and other health professionals, under the guise of “continuing education”, with sponsored talks complete with beautifully-illustrated graphs, the neat throw-away lines that so convincingly and unequivocally tell us why this new drug is the last word, the “ant’s pants”, indeed the veritable God’s gift to medicine, in the treatment of condition X! No side-effects to speak of, well-tolerated, costs a little more, but then think of the superior effectiveness. Golly gee, it will pay for itself in no time with increased quality of life and productivity!
    I firmly believe that every doctor, pharmacist and other health professional with an interest in drugs, owes it to themselves and their clients/patients to actively look for an independent review of that drug or drug product and read it carefully, as a matter of routine.
    Despite protestations to the contrary, (which, I must confess surprise me), keeping your “ear to the ground” with independent high-quality information is not that awfully difficult. There a number of readily-available sources of independent drug information for newly-introduced products; eg. most professional journals associated with each profession. In addition, NPS Radar covers new drugs, and The Australian Prescriber and the NPS newsletter, and provide regular independent updates, and “pearls” of best practice in diagnosis and treatment, indeed. In this day and age, of course, these sources are readily available on line.
    Drug marketing and drug education are two different things. Don’t confuse the two.
    It’s easy to be “Mc educated”- it comes in such delightful marketing packages that often you can’t resist! On the other hand, wouldn’t you rather super-size it and learn the facts?
    Ron Batagol

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#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay