Q&A: No Advertising Please vs Medicines Australia

A group of leading doctors are urging GPs to make a pledge not to see pharma reps.

No Advertising Please campaigners claim the visits may be linked with inappropriate prescribing. The issue remains highly divisive.

Australian Doctor questioned Dr Geoff Spurling, a GP, University of Queensland academic and part of the anti-drug rep campaign, who carried out a 2010 systematic review on the effects of pharma information on doctors’ practice.

We also submitted questions to Dr Martin Cross, chair of Medicines Australia, the representative group for the main pharma companies.

Dr Geoff Spurling

How much research is out there on the effects of drug rep visits on doctors?
There were around 7000 articles that we sifted through. We ended up with 58. These studies were looking at the links between pharma company information and doctors’ prescribing, not just information given during a drug rep visit to a doctor.

We found there was some evidence that exposure to drug company information led to higher prescribing, more costly prescribing and more inappropriate prescribing. There was some evidence that exposure to drug company information had little effect.

But the key message was that we could find no evidence of benefit, no evidence that the information provided to doctors improved prescribing.

How many of the studies you reviewed were focused on GP prescribing in Australia?
Three. One found visits from drug reps was associated with increased prescribing of the promoted drug, one found no difference and one found an increase in generic prescribing when a general practice decided not to see as many drug reps.

If only three, doesn’t it undermine your findings?
No, not at all. Drug companies would not spend enormous sums on visits if they were not going to boost their sales. And the small number of Australian studies were consistent with the review findings overall: no evidence of benefit from information from drug reps.

Does the research show drug rep visits affect patient outcomes?
No, I would like to see independent research looking at patient outcomes ... but I am convinced, based on what we know already, there is no evidence of benefit in seeing drug reps. It is a waste of my time.

One argument you hear is that when seeing drug reps, doctors have the training to distinguish the sales pitch. Doctors love hearing how clever they are but that can make us blind to some of the forces going on in front of us.

One study which found lack of safety information from drug reps in North America also found the doctors rated the quality of this information as good or excellent more than half the time.

Dr Martin Cross

What is the purpose of a drug rep visit?
There is no argument that they visit doctors in order to promote sales of their products. However, there is no direct sale to doctors, and doctors gain no financial benefit from the choice of medicines.  

They provide product information and any promotion must be done in an ethical manner whereby the information provided is current, accurate, balanced, consistent with the approved use of the product and any claims are able to be substantiated.

There is no evidence of any benefit to doctors prescribing as a result of pharma education. How can the industry continue to argue that the visits are about education?
Essentially, [it is] a knowledge transaction. We do not propose that doctors should exclusively obtain their medicine information from pharmaceutical companies.

But no one knows more about a medicine than the company that has researched the medicine. Companies are a trusted and legitimate source of accurate and extensive information for their products.

The Vioxx court case in Australia in 2010 heard evidence that drug companies were misrepresenting the data and information on the safety profile of the drug to GPs. How do you defend that?
The focus of today’s discussion is on our current Code of Conduct and practices which take into consideration best practice and community expectations around the promotion of pharmaceutical products and interactions with healthcare professionals.

Constructive, robust and balanced discussions around how pharmaceutical companies interact with GPs today should focus on today’s evidence.

We do not believe it is constructive in the context of the current discussion to revisit both sides of the debate about events that were alleged to have occurred more than 10 years ago in the Vioxx litigation.

What would be the impact if doctors refuse to see drug reps?
The vast majority of doctors choose to have representative visits or meetings because they find the information provided is useful in keeping their medical practice current.