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Two rules for doctors dealing with pharma reps. First, show some respect…

Dr Geoffrey Spurling from the University of Queensland recently reported for Croakey on a systematic review investigating the impact of pharmaceutical promotion. The authors concluded that medical education should be disentangled from the pharma industry.

He subsequently published this opinion piece in Australian Doctor magazine which may be of interest to Croakey readers.

Geoffrey Spurling writes:

The man in the suit was congenial and efficient as he rolled out sandwiches, pens and clocks while the doctors ignored him and watched his promotional video. I was 16, on work experience at a suburban Brisbane GP surgery and had been invited in for lunch — quite an honour.

What struck me was how rude the doctors were while receiving gifts from the pharmaceutical sales representative. The usual etiquette of expressing gratitude was clearly not in operation in this interaction.

I went on to study medicine at the University of Queensland and enjoyed many drug company-sponsored dinners and events. A night out with your mates and senior colleagues with free alcohol and food was quite irresistible for a cash-strapped medical student. All it cost was a signature for the pleasant sales representative and sometimes a brief presentation about some product or other. I started to expect them. When you are a busy junior doctor, why would you go to a meeting if lunch wasn’t provided?

I became interested in interactions between pharmaceutical companies and doctors after working with Medecins Sans Frontieres in Honduras on a project dealing with Chagas’ disease. The drugs available for this neglected disease of poverty represented a type of market failure as they were developed for veterinary medicine, were only partially effective and had many side effects.

When I returned to Australia, I came to see interactions between pharmaceutical sales reps and doctors through this prism and became concerned that the primary motivation of large, highly profitable pharmaceutical companies is the shareholder rather than doctors. Indeed, it would not make sense for companies to spend $57 billion dollars on promotion in 2004 in the US alone if there was not a share-holder return on this investment.

First, I audited our general practice’s interactions with industry and found that the most heavily promoted drug on post-it notes, pens, models, clocks was … Vioxx!

Each of the seven GPs in our practice was spending at least 40 minutes of consulting time per month on pharmaceutical sales representative visits.

Along with a few other members of Healthy Skepticism, I then spent the next five years conducting a systematic review of all the public scientific literature over the past 40 years, looking at the impact on prescribing of all forms of pharmaceutical information including promotion from sales representatives. Many doctors deny that they are influenced by sales representatives but think that most of their colleagues probably are. We found many studies showed associations between prescribing and sales representative promotion.

I think doctors need to accept that we are more vulnerable to persuasion techniques than we realise. The pharmaceutical industry claims that their information is educational and beneficial. What really surprised us was that we could not find even one study supporting this. We found no clear benefit to prescribing from pharmaceutical promotion and some associations with harm to prescribing. If promotion was a drug, then I think patients would not want their doctors to take that drug.

Pharmaceutical information can also be harmful if it wastes physician’s time or creates a conflict of interest that the public doesn’t like. I was not thrilled to see the cover of a BMJ edition in 2003 portraying doctors as pigs at the trough waited on by pharmaceutical sales representatives characterised as weasels. Some doctors say that seeing reps is okay because they have strict rules for the interaction: “they have to bring lunch”, “they can talk only about new products”, “they have to provide references for their claims”, “I just take the samples but don’t listen to the information”.

My practice manager certainly does not want pharmaceutical sales representatives taking up valuable Medicare-revenue-generating time.

I think it is in the best interests of my patients if I use my precious time by going to independent sources of information. Like the man who recently visited me from the National Prescribing Service. He didn’t give me a pen and he wasn’t wearing a suit, but he told me when to prescribe and also when not to prescribe.

After all this, I only have two rules for pharmaceutical sales representatives: One is to treat them with respect and the other is to not see them.

Dr Spurling is a member of Healthy Skepticism, and senior lecturer in general practice at the University of Queensland.

• This article was first published in Australian Doctor

Comments 2

  1. ron batagol says:

    As a pharmacist who has, over the years, been involved in numerous projects and medication review groups, I endorse everything that Geoffrey Spurling writes about pharmaceutical promotion “masquerading” as education ( my term not his).
    Amongst the various articles that I have written on this topic, was a Feature Article that I wrote for the Auspharm Website in 2004. I think it somewhat reflects what Geoffrey Spurling and others found regarding, what is frankly, nothing more than rank gullibility amongst doctors in believing that they are receiving education, when in fact they are receiving promotion, disguised as education!
    Over the years, I have seen many examples, as the various reviews of Health Scepticism have also demonstrated, of the “cherry-picking” that Drug Companies engage in, to select out articles which support their current promotions. The abstract of my 2004 article “Do you just want to be McEducated or would you rather super-size it and learn the Real Facts?” stated :” I am always amused when I hear colleagues quoting “facts” given to them about a new drug product by the drug company rep. I’m never quite sure whether it is the contents of that free bottle of lovely red wine that the drug rep. left, that has mesmerized their grey matter, whether they have suddenly had a mental aberration, or whether they have simply forgotten all that they have learnt throughout their training and career about assessing and evaluating drug information.”
    I firmly believe that every doctor, ( or pharmacist or 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.

    Keeping your “ear to the ground” will usually mean locating an unbiased, and authoritative source of review of newly-introduced products, eg. a professional journal, The Australian Prescriber, the NPS newsletter, and NPS RADAR .
    Now that may take just a little longer But, guess what? Such reviews are readily available on the Internet, so there’s no excuse for having to default to the selective hotchpotch of Drug Rep leaflets!
    To repeat my take-home message from that article in 2004, which is, I think, just as relevant today as it was back then:
    “ Drug marketing and drug education are two different things. Don’t confuse the two.

    It’s easy to be “McEducated”- it comes in such delightful marketing packages that often you can’t resist! On the other hand, education by learning and evaluating the facts, is something that you have to work at. It’s a hard slog, but it’s definitely worth supersizing your educational investment in the long run!”
    Ron Batagol

  2. zeeclor says:

    It is clear from the studies quoted that drug companies should no longer be allowed to visit doctors, hospitals and pharmacists.

    Should advertising to the public be similarly curtailed?

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social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#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
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences