[india-drug] [e-drug] Accuracy of pharmaceutical advertisements in medical

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Accuracy of pharmaceutical advertisements in medical journals 
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(Posting this info to highlight the fact that publications like CIMS /
MIMS do not fall under the category of ?Drug Information Bulletin? as
expressed in the message written on :?Drug linked to child deaths is
still available in India?
by Sanjay Kumar New Delhi. It is written as follow: ?Dr Chandra Mohan
Gulhati, editor of India?s drug information bulletin, the Monthly Index
of Medical Specialities, said?????

Pharmaceutical ads and info supplied by industry is quite different
from drug information bulletins in its true sense of providing unbiased
drug information.

The Idrug group may please share their thoughts on this issue of ?drug
information? in the Indian context??so that Idrug remains unique in its
discussion and is not Edrug reheated for circulation..SS)



[E-drug] Accuracy of pharmaceutical advertisements in medical journals 

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Regarding interactions between sales representatives and doctors there
are a number of relevant articles that have been published on this
topic. Here is a brief summary of the ones that have investigated the
effects on the quality of prescribing:

Becker MH, Stolley PD, Lasagna L, McEvilla JD, Sloane LM.  Differential
education concerning therapeutics and resultant physician prescribing
patterns.  J Med Educ 1972;47:118-27.
--29 GPs, 3 internists, 5 osteopathic physicians
--more appropriate use of chloramphenicol was related to infrequent use
of journal ads to learn about usefulness of new drugs, disapproval of
detailers as sources of prescribing information for new drugs and a
poor perception of detailers
--better prescribing behaviour for five common illnesses and five
common
complaints and better knowledge of five specified medications was
related to disapproval of detailers as sources of prescribing
information for new drugs and a poor perception of detailers
(prescribing and knowledge assessed by expert panel)


Bower AD, Burkett GL.  Family physicians and generic drugs:  a study of
recognition, information sources, prescribing attitudes, and practices.
 J
Fam Pract 1987;24:612-6.
- mailing to 575 randomly selected GPs from the directory of the
American Academy of Family Physicians ã317 of 501 eligible respondents
- habit of prescribing mostly generic drugs more common among doctors
who relied least on drug company representatives as source of
information on new drugs
- ability to recognize ten out of ten common generic names highest
among
those doctors who relied least on journal advertisements as source of
information on new drugs

Berings D, Blondeel L, Habraken H.  The effect of industry-independent
drug information on the prescribing of benzodiazepines in general
practice.  Eur J Clin Pharmacol 1994;46:501-505.
-surveyed 128 general practitioners in East and West Flanders on their
attitudes about drug information and correlated with the mean number of
packages of benzodiazepines prescribed - the number of commercial
representatives received and the estimated utility of commercial
information (+year of graduation) accounted for 26% of the
variation in the tendency to prescribe benzodiazepines (more recent
graduates prescribed fewer benzodiazepines, those with positive views
about commercial information and those seeing more commercial
representatives prescribed more benzodiazepines)

Caudill TS, Johnson MS, Rich EC, McKinney WP.  Physicians,
pharmaceutical sales representatives, and the cost of prescribing. 
Arch Fam Med 1996;5:201-6.
- 446 Kentucky physicians practicing primary care adult medicine
responded to a survey
- given three case scenarios (acute bronchitis, mild hypertension and
an
uncomplicated urinary tract infection) and offered four choices of
treatment for each case (choices had equal efficacy but widely varying
costs)
- significant positive correlation found between physician cost of
prescribing and perceived credibility, availability, applicability and
use of information provided by pharmaceutical representatives (i.e.,
prescribing costs were higher the more credible doctors found
information from detailers)
- frequency of use of information provided by pharmaceutical
representatives and the group practice setting remained significant
independent positive predictors of cost in the multivariable regression
model

RL Powers, KA Halbritter, JG Arbogast, JL Neely, AJ Williams. Do
interactions with pharmaceutical representatives influence
antihypertensive medication prescribing practices of family medicine
and general internal medicine physicians? Journal of General Internal
Medicine 1998;13(supplement):13.
Despite the 1993 Fifth Joint National Committee (JNC V) recommendation
that hydrochlorothiazide and Beta-blockers be used as first choice
agents "unless they are contraindicated or unacceptable," a recent
study showed increased use of ACE inhibitors and calcium antagonists
and decreased use of diuretics and beta blockers between 1992 and 1995.
 This study examines physician behaviors via a survey of Family
Medicine (FM) and General Internal Medicine (GIM) faculty and residents
and reviews actual prescribing practices. The provision of information
by pharmaceutical representatives at the work site was reported to be
significantly higher for FM than GIM (86% vs 13% >1x per week).  This
study of academic physicians found that those physicians reporting the
greatest amount of interaction with pharmaceutical representatives are
significantly more likely to prescribe ACE inhibitors and/or calcium
antagonists for their hypertensive patients than physicians reporting
low levels of interaction.

Francisco CaamaÒo, Adolfo Figueiras Juan Jesus Gestal-Otero. Influence
of commercial information on prescription quantity in primary care. The
European Journal of Public Health 2002;12:187-91.
Background: In the last few years we have witnessed many
publicly-financed health services reaching a crisis point. Thus, drug
expenditure is nowadays one of the main concerns of health managers,
and its containment one  of the first goals of health authorities in
western countries. The objective of this study is to identify the
effect of the perceived quality stated in commercial information, its
uses, and how physicians perceive the influence it has on prescription
amounts. Methods: A cross-sectional study of 405 primary care
physicians was conducted in Galicia (north-west Spain). The
independent variables physician's education and speciality, physician's
perception of the quality of available drug information sources, type
of
practice, and number of patients were collected, through a postal
questionnaire. Environmental characteristics of the practice were
obtained from secondary sources. Multiple regression models were
constructed using as dependent variables two indicators of prescription
volume. Results: The response rate was 75.2%. Prescription amounts was
found to be associated with perceived credibility of information
provided by medical visitors, regulated physician training, and
environmental characteristics of the practice (primary care team
practice, urban environment). Conclusions: The study results suggest
that in order to decrease prescription amounts it is necessary to limit
the role of pharmaceutical companies in physician training, improve
physician education and training, and emphasize more objective sources
of information.


In addition there have been a number of authors who have investigated
the quality of the information that sales representatives give to
doctors. I have written an article summarizing some of these studies
and I've given the abstract below. La revue Prescrire also has been
conducting an ongoing survey on this topic since the early 1990s and
periodically publishes a summary of the findings.

Lexchin J. What information do physicians receive from pharmaceutical
representatives?  Can Fam Physician 1997;43:941-5.

Objective:  Pharmaceutical sales representatives are seen by most
physicians and influence their prescribing behaviour.  This review was
undertaken in order to assess, in a systematic manner, the information
that sales representatives provide to physicians.
Data Sources:  A MEDLINE search from 1966 to May 1996 was done using
combinations of the following terms:  pharmaceutical industry, drug
information services, drug utilization, physician¼s practice patterns
and prescriptions, drugs.  Studies identified from this search was
supplemented by material from the authors personal library.
Study Selection:  Studies had to meet the following criteria:  they
were
conducted in industrialized countries; they were based on direct
observations of actual physician/sales representative contacts;
and they reported quantitative results about the quality of information
that the sales representatives transmitted.
Syntheses:  A total of five studies were included.  While 
representatives usually mentioned the indications for their drugs, they
usually omitted safety information.  There are also frequent
inaccuracies in the information that representatives transmit.
Conclusion:  Sales representatives present only selected, usually
positive,information about their products to physicians.  Canadian
doctors cannot be passive recipients of the information provided by
sales representatives.
Physicians who chose to continue to see detailers have to critically
compare this information against that contained in scientific
publications.

Joel Lexchin MD
121 Walmer Rd.
Toronto Ontario
Canada M5R2 2X8
Tel:  416-964-7186
Fax:  416-923-9515
e mail:  joel.lexchin@utoronto.ca



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