# \[e-drug\] Reply from Dr Attaran to Dr Srinivas (cont'd)

**URL:** <https://talk.edrugplus.org/t/e-drug-reply-from-dr-attaran-to-dr-srinivas-contd/16470>\
**Category:** e-drug\
**Created:** [March 30, 2003, 7:13am UTC](https://talk.edrugplus.org/t/e-drug-reply-from-dr-attaran-to-dr-srinivas-contd/16470 "2003-03-30T07:13:57Z")\
**Posts on this page:** 1\
**Page:** 1

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**Author:** ![Sarah\_Sellers1](https://avatars.discourse-cdn.com/v4/letter/s/898d66/32.png) [@Sarah\_Sellers1](https://talk.edrugplus.org/u/Sarah_Sellers1)\
**Post date:** [March 30, 2003, 7:13am UTC](https://talk.edrugplus.org/t/e-drug-reply-from-dr-attaran-to-dr-srinivas-contd/16470/1 "2003-03-30T07:13:57Z")

</div>

E-drug: Reply from Dr Attaran to Dr Srinivas (cont'd)  
-------------------------------------------------------------------------

Dr. Srinivas' argument is consistent with what is currently being  
reported in the literature--see references below.

For newly marketed drugs, limited information is available for  
generalizing relatively small clinical trials to the broader populations,  
especially with respect to questions on safety for which average trials  
are not specifically designed to assess.

Many hurried prescribers are under-informed and readily influenced  
by marketing and/or the patient who may also be hurried and readily  
influenced by marketing--in developed countries as well as  
developing. Reporting and publication bias are known to exist, and, in  
the absence of substantial training in epidemiology and the design of  
clinical trials, healthcare professionals may find it challenging to  
define the limitations of data on which marketing approval is based.  
For instance, the generalizability of data to certain patient populations  
may not be warranted, or the data may have a small p-value but have  
very wide confidence intervals. This is where confusion can and does  
occur (it has for me).

Sarah Sellers, PharmD  
Johns Hopkins School of Public Health  
USA  
e-mail: ssellers@jhsph.edu

Some recent literature--

Villanueva P, Peiro S,Librero J, Pereiro I. Accuracy of pharmaceutical  
advertisements in medical journals. Lancet 2003 Jan  
4;361(9351):27-32.

Monaghan MS, Galt KA, Turner PD et al. Student understanding of  
the relationship between the health profession and the  
pharmaceutical industry. Tech Learn Med 2003 winter;15(1):14-20.

Stokamer CL. Pharmaceutical gift giving: analysis of an ethical  
dilemma. J Nurs Adm 2003 Jan; 33(1):48-51.

Mukamal KJ, Markson LJ, Flier SR, Calabrese D. Restocking the  
sample closet: results of a trial to alter medication prescribing. J Am  
Board of Fam Pract 2002 Jul-Aug; 15(4):285-9.

Boltri JM, Gordon ER, Vogel RL. Effect of antihypertensive samples  
on physician prescribing patterns. Fam Med 2002 Nov-Dec;  
34(10):729-31.

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