Stop seeing drug reps, GPs urged

GPs are being urged to say no to seeing drug reps as part of a national campaign that claims the pharma representatives distort doctors' prescribing practice.

The No Advertising Please campaign will be formally launched at the RACGP conference in Adelaide on Saturday by a group of leading doctors and academics, including Professor Paul Glasziou, a GP and professor of evidence-based medicine at Bond University. 

The group is calling on GPs to make a public pledge to refuse to see drug representatives for 12 months, arguing rep visits are about marketing and sales, and not about educating doctors on new medicines.

"We think the campaign will improve care, it will make care safer," Brisbane GP Dr Justin Coleman, one of the campaign organisers, said.

"Many doctors imagined they could 'filter' the company message. But [reps] are highly selective in what they tell you about a drug."

Related News: Video interview with Dr Justin Coleman

On Friday morning 103 health professionals had already signed the petition.

The RACGP has made no official comment on the campaign so far.

But the AMA is not supporting it, branding it "a bit silly".

Dr Brian Morton, chair of the AMA Council of General Practice said: "It is insulting to doctors and naive. Our world revolved around information and education, and the pharmaceutical companies are an important source of money for research."

But the campaigners said they based their claims on a systematic review that examined the effect information provided directly by pharmaceutical companies had on doctors.

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Published in 2010 in PLOS Medicine, the research revealed higher rates of prescribing, higher costs and lower quality prescribing among those who saw pharma representatives.

The paper also said there was no evidence of improvements in prescribing although the available literature "did not exclude the possibility that prescribing may sometimes be improved".

The campaign group also references US research where over 100 doctors were asked how much they thought pharmaceutical reps influenced their prescribing.

Sixty-one per cent thought they had no effect, and only 1% thought they had a big effect.

But when they asked the same doctors how much influence they thoughts reps had on other doctors, the results were different: only 16% thought they had no effect, and 51% believed they had a large effect.

"This suggests that doctors like to imagine they are personally immune to persuasion, despite other doctors being vulnerable. A bit like the way most people like to imagine themselves as better-than-average drivers," the campaign website states.

There are no national figures on the number of drug rep visits taking place each year.

A 2008 survey of 180 GPs, carried out by consumer group Choice, found they received on average seven visits a month, with 65% of the GPs seeing more than one drug rep a week.

The survey claimed 73% of GPs used reps as a source of information and for 16%, reps were the main source of information when they're deciding whether or not to prescribe a new drug

Medicines Australia, the representative group for the main drug companies in Australia, said the visits were about education and supported doctors in treating patients.

It said reps were "purveying information ... to make sure that the product is used properly".

“These campaigners must have very low regard for doctors’ ability to clinically assess and prescribe the most suitable treatment for their patients," said Medicines Australia chairman Dr Martin Cross.

“By barring contact with company representatives, it would be like having open heart surgery knowing that the surgeon hasn’t been taught how to use the equipment by the people that made it," he said.

Another issue raised by the No Adertising Please campaign was access to free samples, used by many GPs to support treatment of poor patients.

"I used to accept the free samples," Dr Coleman said. "But I don't think it benefits patients.

"Maybe if the companies were offering antibiotics, you could see the advantage. But the medications are usually for life-long conditions, the supplies are short-term.

"I also think it is not good to based your prescribing decisions on what's in the cupboard from the last three rep visits."  

However, Queensland GP Dr Peter Bradley said although he rarely saw drug reps because their visits took up valuable time, he did not support the campaign.

“I don’t think anyone should go around saying ‘you GPs should not see these people’,” he said.

Dr Bradley said after decades in practice, he could confidently educate himself about new drugs by reading widely, but reps still had a role to play in educating younger, less experienced doctors.

“The benefit is just negated a little bit by this tendency to focus on the few select and most profitable drugs,” he said.

“Obviously the information they give you is slanted to put their drug in a favourable light and they don’t jump up and down too much about anything too unfavourable; you expect that though.”