But surely pharmaceutical reps offer useful education for doctors?

Some doctors think so, finding encounters with pharmaceutical reps useful and convenient (Prosser).

But there are reasons to be concerned about the accuracy of information from reps. A study by Barbara Mintzes and colleagues found that in Canada, France and the USA, patient safety information was often missing from pharmaceutical rep visits – even ‘minimally adequate’ safety information was presented by reps less than 2% of the time. (Mintzes)

Similarly, a study by Noordin Othman and colleagues found that, in Australia and Malaysia, information on risks and harms from medicines was often missing in reps’ encounters with GPs. (Othman) A US survey found that more than half of ‘high-prescribing’ doctors cited drug reps as their main source of information about new drugs. (Millenson)

Doctors tend to think they can ‘sort the wheat from the chaff’ amongst information from reps, discarding the more biased information and believing only what was more likely to be true. Are we to trust their belief in this ability?

Michael Steinman and colleagues asked over 100 doctors how much they thought pharmaceutical reps influenced their prescribing. Sixty-one per cent thought they had no effect, and only 1% thought they had a big effect. But when they asked the same doctors how much influence they thoughts reps had on other doctors, the results were different: only 16% thought they had no effect, and 51% believed they had a large effect. (Steinman)

This suggests that doctors like to imagine they are personally immune to persuasion, despite other doctors being vulnerable – a bit like the way most people like to imagine themselves as better-than-average drivers!

If you find yourself agreeing with the 99% of surveyed doctors who felt that reps had no big effect on their prescribing, perhaps reflect on why pharmaceutical companies keep bothering to send them to your door.

And if, like half of all doctors, you agree that reps do have a large effect on other doctors— and evidence suggests this leads to lower quality prescribing—you might choose to do your bit to diminish the influence of reps by signing our pledge. Why encourage a system which can potentially worsen outcomes for patients, even if they are the patients of other doctors?

The Blue Cross report ‘Getting doctors to say yes to drugs’ indicates that although the pharmaceutical industry’s stated purpose is to encourage “the right drug for the right person at the right time,” too frequently the opposite is encouraged:

Examples would include marketing that leads physicians to prescribe drugs where no drug therapy is indicated; to prescribe high-cost drugs when lower-cost drugs would be equally effective; or to prescribe a wrong category of drug. In each instance, excess costs are added to the health-care system.

Millenson

Peter Mansfield and other experts in this area point out that there is no proven method for helping doctors to be better at distinguishing reliable from unreliable promotional information, and that it is safer instead to encourage doctors, and doctors-in-training, to avoid reps altogether. (Mansfield)

References