Prescribing physicians may have reason to be wary of claims made by pharmaceutical sales representatives, Canadian researchers are reporting in an international study.
“This study is a bit of a wake-up call in terms of the quality of information doctors are getting,” said Barbara Mintzes, lead author and assistant professor at UBC. “Drug promotion hasn't been taken very seriously as a public health issue. It's seen more as a marketing issue, as such, the activities of sales representatives are not being monitored.”
In the study, which appeared last week in the Journal of General Internal Medicine, 704 physicians completed a questionnaire in Vancouver and Montreal as well as in Sacramento, Calif., and Toulouse, France. Participants were required to not only see sales representatives in order to be eligible, but must also have worked at least 20 clinical hours per week and served more than 50 percent of their primary care patients. Physicians belonging to advocacy groups against promotion and pharmaceutical company employees were excluded.
Researchers discovered that, overall, only 41 percent of sales representatives provided prescribing physicians with knowledge of potentially harmful side effects of the medications they were promoting. Conversely, 80 percent of visits included the drugs’ beneficial qualities.
“Doctors don’t get the straight goods,” said Dr. Tom Perry, an internal medicine and clinical pharmacology specialist at the UBC Hospital in Vancouver, British Columbia, not associated with the study. “We should be getting the whole truth on the medications we dispense, and lies are ultimately going to be very damaging to our patients.”
Even more troubling is the fact that serious adverse effects – or what the U.S. Food and Drug Administration terms “black box” warnings – were mentioned in just 5-to-6 percent of promotions over all four sites. Black box warnings indicate potentially life-threatening risks associated with the medications, and are not typically provided on sample packs.
“If a doctor is prescribing medication based on incomplete information, there certainly can be a problem in terms of patient safety being compromised,” Mintzes explains.
However, as Perry notes, patients can sometimes find themselves in a precarious situation if faced with a doctor who is either ill-informed or doesn’t have their best interests in mind.
“Patients are in the weakest possible position when seeking help from a psychiatrist, specifically if they’re depressed, because they’re desperate,” Perry said. “It’s rare for a patient to be bold enough to confront a doctor with questions about their motives, or if they’re being protected from bias.”
Not all doctors are easily influenced, however. Some even prefer to avoid accepting sales visits entirely.
“I’m someone who’s always been pretty skeptical of the pharmaceutical industry,” said Dr. Michael Marcangelo, director of medical student education at the University of Chicago. “I’ve stayed away for scholarly reasons, because there are many studies that found representatives really do influence doctors. I think the best strategy is not to have contact.”
Yet, he pointed out that acceptance of promotions is deeply engrained in medical culture, especially from private practices, because it can be the only chance they have to learn about new medications.
This can be a double-edged sword, according to Mintzes.
“Often the first few years drugs are on the market is when they are heavily promoted,” she said. “But this means they’re typically at a point where knowledge of longer-term harmful effects or if it has clinical benefits are often incomplete.”
In the end, Marcangelo’s strategy of avoidance is echoed in the study as perhaps the most effective way to ensure prescribing decisions are based on scientific literature rather than biased, corporate sales pitches.
Several major Illinois-based pharmaceutical companies as well as the FDA were contacted but were unavailable for comment.