Drug Reps Often Fail to Tell Doctors of Warnings, Study Says
Many doctors prescribe drugs even after drug company reps fail to provide little or no information about the harmful side effects, a process known as "detailing."
Researchers at the University of British Columbia in Vancouver surveyed 255 doctors in three countries. They found that in up to 66 percent of cases, drug company sales representatives failed to disclose any potential dangers of the drugs they were selling, despite laws requiring them to do so.
"Laws in all three countries require sales representatives to provide information on harm as well as benefits," said Barbara Mintzes, PhD, study author and assistant professor in the School of Population and Public Health at the University of British Columbia. "But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion."
According to the study, 64 percent of doctors said they were somewhat likely or very likely to prescribe 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.
"Sales reps are advertisers, not educators," said Dr. Perry, who was not involved in the study. "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 said that it's up to the patient to understand what they are putting into their bodies. He also urged patients to ask their doctors how often they meet with drug company sales reps, according to Everyday Health.
"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."
The researchers analyzed a total of 1,692 drug promotion visits between May 2009 and June 2010 and asked doctors to fill out a questionnaire about the information which the representative provided. The study found that while 57 percent of the medications presented in the sales visit were labeled with a "Black Box" safety warning from the U.S. Food and Drug Administration or Health Canada's boxed warning, doctors were only informed of the warnings during 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.
It would be very difficult to stop the barrage of pharmaceutical advertising aimed at doctors, says Perry.
"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."
The American Medical Association (AMA) does not currently have guidelines for meetings between doctors and pharmaceutical representatives. However, the association does urge both parties to maintain a "professional" relationship, warning doctors to beware of accepting gifts or any other incentives intended to persuade their opinion to switch patients off competing drugs. Gifts are acceptable but the AMA has strict guidelines on what can be given. States like Massachusetts and Minnesota have strictly 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 states on its website. "For example, it would be appropriate for a physician to receive a stethoscope, but not a golf bag."