[e-drug] The pharmaceutical industry and doctors' prescribing habits

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The pharmaceutical industry and doctors' prescribing habits
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[Thanks to Beverley for spotting this. WB]

Australian national radio program Okham's Razor, October 14, 2007, 
featured Professor Christopher Nordin, visiting Professor at the 
University of Adelaide and a consultant physician at the Royal Adelaide 
Hospital discussing the increasing influence of the pharmaceutical 
industry on the medical profession. Extracts from his talk are presented 
below.

'In Australia, the immediate pressure on the medical profession comes 
from the travelling reps who seek and obtain regular interviews with 
General Practitioners and specialists. At these sessions, 
representatives talk up, and provide reprints on published 
industry-sponsored Randomised Control Trials These trials, often 
international in scope and running to thousands of cases and controls, 
are often financed so generously that the funding places the 
investigator under an obligation. How much more obligated must doctors 
feel who accept positions on advisory boards or act as consultants to 
industry. How can such positions fail to influence their prescribing 
habits, and even the advice they give when consulted about the merits of 
a particular drug? How can advice given by consumer groups to the 
authorities be impartial when these consumer groups are themselves 
largely or wholly financed by the pharmaceutical industry?

'Another inducement is the prospect of a future publication to add to 
our C.V. Richard Smith, respected editor of the British Medical Journal 
for many years, has said that studies funded by industry are subtly 
manipulated to give positive results and are four times more likely to 
have positive results than those funded by other sources.

'In Australia, the Pharmaceutical benefits Advisory Committee (PBAC) is 
under constant pressure from the pharmaceutical industry to subsidise 
expensive new preparations and when it seeks outside advice, the 
advisers are likely to be receiving support from one or other of the 
companies sponsoring the application. This has the effect of making a 
public body financially dependent on the industry it is supposed to be 
regulating. Is the government that pushes this policy not aware that he 
who pays the piper calls the tune?

'Another way in which the industry exerts pressure on doctors is by 
offering us a variety of professional services. In one of these 
services, widely advertised to GPs, a company representative shows the 
Practice Manager how to use a company disk to 'trawl' through the 
practice database identifying patients with problems which might be 
treatable with the company's products. When that has been done, a 
company-sponsored nurse interviews the selected patients and draws up a 
management plan for the GP which, if approved by the doctor, attracts a 
Medicare item number. One of these companies proudly announces that over 
65,000 patients were assessed in this way in 2005. What, one may ask, is 
a pharmaceutical company doing assessing patients?
 
'And then there is the ultimate consumer, the patient. Drug companies 
are not allowed to advertise prescription drugs directly to the public, 
but they can achieve the same effect in other ways. One is to sponsor on 
commercial television a health promotion advertisement about a common 
condition. When they arrive in the doctor's surgery, they are pleased to 
learn that a new drug has just appeared on the market and that the 
doctor will be happy to prescribe it. What a coincidence!

'I have tended to blame the pharmaceutical companies for their undue 
influence on prescribing. It could be argued, however, that they are 
only doing their duty to their shareholders by maximising their profits; 
it is as much the fault of the medical profession, some say, in allowing 
itself to be manipulated. I asked a lawyer whether it is the briber or 
the bribed who commits the offence of bribery. 'Both', he replied. 
Perhaps that sums it up.'