E-drug: Accuracy of pharmaceutical advertisements in medical journals (cont)
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Regarding interactions between sales representatives and doctors there are a
number of relevant articles that have been published on this topic. Here is
a brief summary of the ones that have investigated the effects on the
quality of prescribing:
Becker MH, Stolley PD, Lasagna L, McEvilla JD, Sloane LM. Differential
education concerning therapeutics and resultant physician prescribing
patterns. J Med Educ 1972;47:118-27.
--29 GPs, 3 internists, 5 osteopathic physicians
--more appropriate use of chloramphenicol was related to infrequent use of
journal ads to learn about usefulness of new drugs, disapproval of detailers
as sources of prescribing information for new drugs and a poor perception of
detailers
--better prescribing behaviour for five common illnesses and five common
complaints and better knowledge of five specified medications was related to
disapproval of detailers as sources of prescribing information for new drugs
and a poor perception of detailers (prescribing and knowledge assessed by
expert panel)
Bower AD, Burkett GL. Family physicians and generic drugs: a study of
recognition, information sources, prescribing attitudes, and practices. J
Fam Pract 1987;24:612-6.
- mailing to 575 randomly selected GPs from the directory of the American
Academy of Family Physicians �317 of 501 eligible respondents
- habit of prescribing mostly generic drugs more common among doctors who
relied least on drug company representatives as source of information on new
drugs
- ability to recognize ten out of ten common generic names highest among
those doctors who relied least on journal advertisements as source of
information on new drugs
Berings D, Blondeel L, Habraken H. The effect of industry-independent drug
information on the prescribing of
benzodiazepines in general practice. Eur J Clin Pharmacol 1994;46:501-505.
-surveyed 128 general practitioners in East and West Flanders on their
attitudes about drug information and correlated with the mean number of
packages of benzodiazepines prescribed
- the number of commercial representatives received and the estimated utility
of commercial information (+year of graduation) accounted for 26% of the
variation in the tendency to prescribe benzodiazepines (more recent
graduates prescribed fewer benzodiazepines, those with positive views about
commercial information and those seeing more commercial representatives
prescribed more benzodiazepines)
Caudill TS, Johnson MS, Rich EC, McKinney WP. Physicians, pharmaceutical
sales representatives, and the cost of prescribing. Arch Fam Med
1996;5:201-6.
- 446 Kentucky physicians practicing primary care adult medicine responded to
a survey
- given three case scenarios (acute bronchitis, mild hypertension and an
uncomplicated urinary tract infection) and offered four choices of treatment
for each case (choices had equal efficacy but widely varying costs)
- significant positive correlation found between physician cost of
prescribing and perceived credibility, availability, applicability and use
of information provided by pharmaceutical representatives (i.e., prescribing
costs were higher the more credible doctors found information from
detailers)
- frequency of use of information provided by pharmaceutical representatives
and the group practice setting remained significant independent positive
predictors of cost in the multivariable regression model
RL Powers, KA Halbritter, JG Arbogast, JL Neely, AJ Williams. Do
interactions with pharmaceutical representatives influence antihypertensive
medication prescribing practices of family medicine and general internal
medicine physicians? Journal of General Internal Medicine
1998;13(supplement):13.
Despite the 1993 Fifth Joint National Committee (JNC V) recommendation that
hydrochlorothiazide and Beta-blockers be used as first choice agents "unless
they are contraindicated or unacceptable," a recent study showed increased
use of ACE inhibitors and calcium antagonists and decreased use of diuretics
and beta blockers between 1992 and 1995. This study examines physician
behaviors via a survey of Family Medicine (FM) and General Internal Medicine
(GIM) faculty and residents and reviews actual prescribing practices. The
provision of information by pharmaceutical representatives at the work site
was reported to be significantly higher for FM than GIM (86% vs 13% >1x per
week). This study of academic physicians found that those physicians
reporting the greatest amount of interaction with pharmaceutical
representatives are significantly more likely to prescribe ACE inhibitors
and/or calcium antagonists for their hypertensive patients than physicians
reporting low levels of interaction.
Francisco Caama�o, Adolfo Figueiras Juan Jesus Gestal-Otero. Influence of
commercial information on prescription quantity in primary care. The
European Journal of Public Health 2002;12:187-91.
Background: In the last few years we have witnessed many publicly-financed
health services reaching a crisis point. Thus, drug expenditure is nowadays
one of the main concerns of health managers, and its containment one of the
first goals of health authorities in western countries. The objective of
this study is to identify the effect of the perceived quality stated in
commercial information, its uses, and how physicians perceive the influence
it has on prescription amounts. Methods: A cross-sectional study of 405
primary care physicians was conducted in Galicia (north-west Spain). The
independent variables physician's education and speciality, physician's
perception of the quality of available drug information sources, type of
practice, and number of patients were collected, through a postal
questionnaire. Environmental characteristics of the practice were obtained
from secondary sources. Multiple regression models were constructed using as
dependent variables two indicators of prescription volume. Results: The
response rate was 75.2%. Prescription amounts was found to be associated
with perceived credibility of information provided by medical visitors,
regulated physician training, and environmental characteristics of the
practice (primary care team practice, urban environment). Conclusions: The
study results suggest that in order to decrease prescription amounts it is
necessary to limit the role of pharmaceutical companies in physician
training, improve physician education and training, and emphasize more
objective sources of information.
In addition there have been a number of authors who have investigated the
quality of the information that sales representatives give to doctors. I
have written an article summarizing some of these studies and I've given the
abstract below. La revue Prescrire also has been conducting an ongoing
survey on this topic since the early 1990s and periodically publishes a
summary of the findings.
Lexchin J. What information do physicians receive from pharmaceutical
representatives? Can Fam Physician 1997;43:941-5.
Objective: Pharmaceutical sales representatives are seen by most physicians
and influence their prescribing behaviour. This review was undertaken in
order to assess, in a systematic manner, the information that sales
representatives provide to physicians.
Data Sources: A MEDLINE search from 1966 to May 1996 was done using
combinations of the following terms: pharmaceutical industry, drug
information services, drug utilization, physician�s practice patterns and
prescriptions, drugs. Studies identified from this search was supplemented
by material from the author�s personal library.
Study Selection: Studies had to meet the following criteria: they were
conducted in industrialized countries; they were based on direct
observations of actual physician/sales representative contacts;
and they reported quantitative results about the quality of information that
the sales representatives transmitted.
Syntheses: A total of five studies were included. While representatives
usually mentioned the indications for their drugs, they usually omitted
safety information. There are also frequent inaccuracies in the information
that representatives transmit.
Conclusion: Sales representatives present only selected, usually positive,
information about their products to physicians. Canadian doctors cannot be
passive recipients of the information provided by sales representatives.
Physicians who chose to continue to see detailers have to critically compare
this information against that contained in scientific publications.
Joel Lexchin MD
121 Walmer Rd.
Toronto Ontario
Canada M5R2 2X8
Tel: 416-964-7186
Fax: 416-923-9515
e mail: joel.lexchin@utoronto.ca
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