The Pharmaceutical Industry & Drug Reps

First comment is from the GMC (always a good place to start).

Conflict of interest

You must act in our patients’ best interest when making referrals and providing or arranging treatment or care. So you must not ask for or accept any inducements, gift or hospitality which may affect or be seen to affect your judgement.

            GMC good medical practice.

The BMA expanded this to say:

Accepting gifts and lavish hospitality is an area of danger. You should not accept gifts other than trivial ones and you must never demand fees to see sales representatives. Drug company sponsorship of educational events is acceptable, but the level of that sponsorship should not be capable of misinterpretation. If you dispense drugs to your patients, you should not accept inducements that might influence your prescribing.

WHAT does this look like in practice??

But does it really affect us??

A BMJ Article BMJ 2003;326:1178-1179 reported that GP's who saw drug representatives were more likely to prescribe new drugs for patients. They also reported that frequent contact with drug representatives was strongly and independently associated with higher prescribing costs. Drug companies spend more on marketing than on research).

What are the positives and negatives about doctors seeing drug representatives? (Think of how these impacts on as many groups as you can- e.g. patients, doctors etc)

A BMJ article BMJ 2003;326:1167-1170 investigated whether funding of drug studies by the pharmaceutical industry is associated with bias. After examining 30 studies they found that although drug industry sponsored research was just as methodologically sound, they were more likely to be favourable to the funder. Explanations include selection of an inappropriate comparator and publication bias.

Imagine you are a new partner in the practice and they are considering employing a research nurse to conduct drug company sponsored research. What points would you raise in the discussion?

The site gives links to papers and editorials which seek to define or discourage connections between drug companies and Doctors. It also gives practical tips on things you can do e.g. hold a “no free lunch just say no to drug reps” lunch??? Or you can buy memorabilia e.g. badges, mugs, pens, tee-shirts (in American dollars)

Drug Reps: Not all bad

• So many new drugs on the market with specific indications that drug reps play an important educational role for up to date GP’s, often providing comparative evidence.
• They provide free samples that can be used if a patient can’t always afford the prescription/private fee, or patients can try a sample to see if it helps.
• Sponsored educational seminars and meetings, without which doctors or the NHS would have to bear the cost.
• Drug companies need to market their products and drug reps are one of the legitimate marketing strategies.
• Drug companies fund expensive research, without which some drugs may never have been developed.
• 60% of doctors admit that they’ve enjoyed some of the perks sponsored by drug reps.
• Speaking to a drug rep does not necessarily mean that our prescribing will change, each doctor should be able to make their own choice (autonomy).
• If we as a collective truly do not appreciate or want drug reps then why do we use their pens, mugs, stationary etc ?

Reps Love them or hate them they are part of life at the moment. But what do they think?

But have you ever taken advantage of the system? Talk in the groups about perks people have had.

Finally

Should drug companies be allowed to talk directly to patients??

YES

Helps with diagnosis and treatment may save money

Helps patients to become equal partners in decision making

Gives them the ability to make informed choices

Patients must be able to gain access to high quality, accurate balanced information.

NO

Adverting does not equate to high quality information

Advertising is designed to “sell” a product

Celebrity endorsement eg Pele in Pfizer ads for impotence.

Maximises benefits minimizes risks

BMJ 2003;326:1302-1303

USA

Direct to consumers (DTC) advertising has attracted billions of dollars from drug companies since rules governing mass media advertising for prescription drugs were relaxed in 1997.

Think about some Patient Education Groups which are sponsored by drug companies. Can you think of any explains and pros and cons??

To see if the drug companies are winning here are some questions that Doctors net were using to assess which brands had influence. Answers next week!

The questions were - what is your first choice drug for:

1. Statin for CHD

2. PPI for dyspepsia/GORD

3. SSRI for depression

4. Ang2 antag for hypertension

5. Drug for ED

6. Urinary incontinence

7 Add on therapy for asthma

8. Add on therapy for asthma

So, do you all think of the same drugs?