E-DRUG: How to read a paper
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Dear E-druggers,
Summary points from this week's article in the above series in
the British Medical Journal follows:
Syed Rizwanuddin Ahmad
Email: srahmad@essential.org
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BMJ No 7106 Volume 315
Education and debate Saturday 16 August 1997
How to read a paper
Papers that report drug trials
Trisha Greenhalgh
This is the sixth in a series of 10 articles introducing
non-experts to finding medical articles and assessing their
value
"Evidence" and marketing
If you prescribe drugs, the pharmaceutical industry is interested
in you and is investing a staggering sum of money trying to
influence you. The most effective way of changing the prescribing
habits of a clinician is through personal representatives (known in
Britain as "drug reps" and in North America as "detailers"), who
travel round with a briefcase full of "evidence" in support of their
wares.
Pharmaceutical "reps" do not tell nearly as many lies as they used
to (drug marketing has become an altogether more sophisticated
science), but they have been known to cultivate a shocking ignorance
of basic epidemiology and clinical trial design when it suits them.
It often helps their case, for example, to present the results of
uncontrolled trials and express them in terms of before and after
differences in a particular outcome measure.
Summary points
Pharmaceutical "reps" are now much more informative than they
used to be, but they may show ignorance of basic epidemiology and
clinical trial design
The value of a drug should be expressed in terms of safety,
tolerability, efficacy, and price
The efficacy of a drug should ideally be measured in terms of
clinical end points that are relevant to patients; if surrogate
end points are used they should be valid
Promotional literature of low scientific validity (such as
uncontrolled before and after trials) should not be allowed to
influence practice
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