By Amir Khan
Drug company reps provide little or no information about harmful side effects of the medications they are selling when they visit doctors' offices, a process called "detailing", but many doctors prescribe the drugs anyway.
The survey of 255 doctors in three countries by researchers at the University of British Columbia in Vancouver found that in up to 66 percent of cases, drug company sales representatives failed to disclose any potential dangers of their drugs, despite laws requiring otherwise.
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"Laws in all three countries require sales representatives to provide information on harm as well as benefits," Barbara Mintzes, PhD, study author and assistant professor in the School of Population and Public Health at the University of British Columbia, said in a statement. "But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion."
On average, 64 percent of doctors said they were either very likely or somewhat likely to prescribe the medications. The findings show the power that advertising has over doctors, said Thomas Perry Jr., MD, clinical assistant professor in the department of medicine at the University of British Columbia, who was not involved in the study.
“Sales reps are advertisers, not educators,” said Dr. Perry. “Their role is to persuade individual doctors to prescribe more of their company's products, to drive sales. If they alerted doctors to the more serious or common adverse effects, doctors would be less likely to prescribe such drugs, and more likely to recognize such adverse events.”
Perry added that it’s up to the patient to understand what they put into their bodies, and he urged patients to ask their doctors how often they meet with drug company sales reps.
“If the doctor offers a sample, ask the practitioner whether they recently received a promotional visit for this drug, and ask for detailed information about it,” Perry said. “Read the product insert carefully, and know why you are taking any medication.”
Compromising Patient Safety
The researchers looked at a total of 1,692 drug promotion visits between May 2009 and June 2010, and had doctors fill out a questionnaire about the information provided by the representative. They found that even though 57 percent of the medications involved in the sales visits carried either a U.S. Food and Drug Administration “Black Box” safety warning or Health Canada’s boxed warnings – the strongest drug warnings issued by either country – doctors were informed of the warnings in only 6 percent of the promotional visits.
"We are very concerned that doctors and patients are left in the dark and patient safety may be compromised," Mintzes said in a statement.
Stopping the barrage of pharmaceutical advertising aimed at doctors would be very difficult, Perry said.
“One could provide a checklist [similar to the kind in this study] and require the sales rep to ensure that this is completed independently by the doctor and returned independently to a regulatory agency by the doctor after each visit,” Perry said. However, I doubt this would be feasible, and the advertisers would likely find a way to circumvent the effect.”
Instead, he urged doctors to decline to spend time with sales reps, and, if they do decide to meet, research the drug beforehand.
“Doctors should take the same approach as an intelligent consumer customer,” said Perry. “Ask directly what the drawbacks are, and ask for more information on comparative studies of the new product versus alternatives.”
The American Medical Association does not have guidelines for meetings between doctors and pharmaceutical representatives, but urges both parties to keep the relationship “professional” and tells doctors to beware of accepting gifts or other incentives intended to persuade them to switch patients off of competing drugs. And while gifts are acceptable, the AMA has strict guidelines on what can be given. Some states, such as Massachusetts and Minnesota, have banned all gifts to doctors.
“Manufacturer gifts and services to physicians must primarily benefit patients or be for the education of the physician, not be of substantial value (under $100) and only offered occasionally,” the AMA says on its website. “For example, it would be appropriate for a physician to receive a stethoscope, but not a golf bag.”
"Drug Reps Often Fail to Inform Docs of Side Effects" originally appeared on Everyday Health.