Media Release: Doctors launch campaign to ban pharmaceutical rep visits

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A new alliance of Australian doctors is pledging to ban pharmaceutical company representatives from “educational” visits to their practices in a national campaign aimed at reducing the prescription of medications in inappropriate and potentially harmful ways.

The “No Advertising Please” campaign is to be launched at the annual conference of the Royal Australian College of General Practitioners in Adelaide on Saturday, October 11.

As part of the campaign, doctors will sign a pledge declining to see for a year visiting drug company representatives who routinely call on many medical practices, providing a light lunch in exchange for the opportunity to promote their company’s products to the doctors.

In the lead up to the launch, more than 50 doctors from across Australia have already signed the pledge.

The NAP group sponsoring the campaign cites research studies which have found that doctors receiving information from pharmaceutical companies – including from drug rep visits – is associated with increases in prescriptions of promoted drugs, decreased quality of prescribing and increased costs.[i] They also cite research that drug reps make inaccurate claims favourable to their drug, but made accurate and non-favourable claims about their competitors’ drugs.[ii] Most doctors could not recall any false statements from these interactions.

In a study of Australian GPs from 2010, only around half of presentations from sales representatives included information about side effects, drug interactions and contraindications.[iii] Similarly in a 2013 study in France, Canada and the US, harms were mentioned in fewer than half of encounters with pharmaceutical sales representatives, and this included drugs with known serious side effects and black box warnings.[iv]

The prescribing of some aggressively promoted drugs has been linked to many thousands of people being harmed unnecessarily, with companies sometimes withholding important safety information or exaggerating drug benefits. (See reports below)

NAP spokesperson, Brisbane GP Dr Justin Coleman, said the campaign was not seeking to demonise pharmaceutical companies which produced so many life-improving drugs. “But we do want to discourage the routine acceptance by doctors of the promotion of drugs in this way.

“The associated perks may be minor but the research shows such marketing tends to raise the risk of patients getting inappropriate medicines.

“That is an unacceptable state of affairs which erodes patient trust in their doctor. At a time when there are increasing numbers of accessible sources of independent evidence-based information on medicines, NAP is aimed at strengthening the prescribing credibility of doctors in Australia,” Dr Coleman said.

The Consumers Health Forum of Australia has welcomed the campaign “as an important sign that doctors’ prescribing decisions are based on best independent evidence.

“The NAP campaign brings a new and refreshing level of transparency into medical practice,” the Chief Executive Officer of CHF, Adam Stankevicius said. “It can only boost the level of trust patients place in their doctors to see a NAP poster in their waiting rooms.”

Dr Coleman said: “Many of our colleagues will say they are not unduly influenced by drug company reps, but the research shows that those who see reps often are more likely to prescribe their products, and likely to prescribe more inappropriately”

“And why would the pharmaceutical companies spend literally billions of dollars worldwide on these marketing practices if they were not reaping profits from these so-called “educational” sessions?

“Some GPs enjoy the social interaction with reps and the time out from a busy practice. Some GPs find the gifts, sponsorship or lunch from pharmaceutical companies important, or simply enjoy the perks, even when there is an implied reciprocal obligation to prescribe a company’s drug,” Dr Coleman said.

“Doctors are all vulnerable to being misled by skilfully-presented information while there are better, independent sources of information about drugs, such as Australia’s NPS MedicineWise and the Australian Medicines Handbook.

Some examples of misleading promotion of medicines marketed in Australia:

  • Vioxx: aggressive and misleading promotion played down the risk of heart attacks of pain drug Vioxx[v](rofecoxib) and the manufacturer ultimately paid a fine of almost US$1 billion in the US, including for offences related to illegal marketing of the drug[vi]
  • Pradaxa: A BMJ investigation recently reported that important safety information was not publicly available about the aggressively marketed anti-coagulant for stroke prevention, Pradaxa (dabigatran)[vii] ; the manufacturer also recently settled litigation in the United States, for US$650 million, relating to allegations the drug caused serious and sometimes fatal bleeding[viii]
  • Avandia: Its manufacturer faced a record US$3 billion fine in 2012, in part because it failed to report safety data about its heavily promoted type 2 diabetes drug Avandia (rosiglitazone) which was linked to heart problems[ix]
  • Tamiflu: Following several years of campaigning, researchers finally succeeded in obtaining internal company data on the popular flu drug Tamiflu (oseltamivir): evidence showed modest benefits, and risk of side effects, and led researchers to question whether the drug should be stockpiled to fight pandemics[x]

 

References

[i] Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, et al. (2010) Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians’ Prescribing: A Systematic Review. PLoS Med 7(10): e1000352

[ii] Ziegler MG , Lew P, Singer BC. The accuracy of drug information from pharmaceutical sales representatives. JAMA 1995; 273 :1296–-8.

[iii] Othman N, Vitry AI, Roughead EE, Ismail SB, Omar K. Medicines information

provided by pharmaceutical representatives: a comparative study in Australia and

Malaysia. BMC Public Health. 2010 Nov 30;10:743.

[iv] Mintzes B, Lexchin J, Sutherland JM, Beaulieu MD, Wilkes MS, Durrieu G, Reynolds E. Pharmaceutical sales representatives and patient safety: a comparative prospective study of information quality in Canada, France and the United States. J Gen Intern Med. 2013 Oct;28(10):1368-75.

[v] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779871/

[vi] http://www.nytimes.com/2011/11/23/business/merck-agrees-to-pay-950-million-in-vioxx-case.html?_r=0

[vii] http://www.bmj.com/investigation/dabigatran

[viii] http://www.nytimes.com/2014/05/29/business/international/german-drug-company-to-pay-650-million-to-settle-blood-thinner-lawsuits.html

[ix] http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all

[x] http://www.bmj.com/content/348/bmj.g2545


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