PsychoTropical Research - Dr Ken Gillman, Serotonin Syndrome, Mirtazapine, Dual Action Drugs. Drug Rep Visits - To see or not to see?.

PsychoTropicalResearch, serotonin and serotonin syndrome research.

Drug Rep Visits - To see or not to see?

Drug Rep Visits - To see or not to see?

Date Created: 19/01/2000   Last Modified: 03/01/2003   Last Checked: 03/01/2003

Current estimates put total drug company promotional budgets worldwide at well over 2 billion $US.

There are complex issues involved in our relationship with the pharmaceutical industry. The old adage "he who pays the piper calls the tune" is apposite.

Gillman's maxim No 9

"Considering sponsored drug trials to be reliable and objective evidence may be compared to buying a second hand car after getting the salesman to take it for a test drive for you."

Western governments have devolved costs to industry. This has resulted in drug companies controlling more and more of the finances related to post graduate medical education. They therefore have INFLUENCE ON WHAT INFORMATION IS, or is not, PRESENTED TO DOCTORS. It is self-evident that as commercial organisations they will wish to show their products in the best light. That means their objectivity in deciding what to bring, or not to bring, to doctors attention could be compromised. Almost all medical journals are dependant on money from drug companies in order to exist; so whatever anyone tells you it would naive to imagine this does not influence them.

Companies engage in promotional activities because that succeeds in getting their drugs a place in the market that the scientific evidence does not always justify or support; you may not think may it influences you as an individual, but it works. If it did not then the companies would not spend billions of dollars on it.

There is sound evidence that doctors who get a greater proportion of their information from drug representatives are less rational prescribers.

That there is substance to these views is highlighted by this recent reference "Physicians and the pharmaceutical industry: is a gift ever just a gift?" and by recent disclosures about fluoxetine.

There are several recent and expensive antidepressant drugs that are already proving of doubtful efficacy; indeed one or two of them may already be 'gone' by the time you read this.

What part has 'advertising' played in bringing about their temporary success; and what part have we played in colluding with the promotional system which allows that? Could our patients be paying for the free lunch we receive, or is there no such thing?

We are under increasing public scrutiny. Some doctors may consider that a more defendable option is to see representatives from drug companies in the context of meetings organised through appropriate professional bodies where expert colleagues (who usually chooses them?) in that field are available to participate in comment and discussion. These meetings might be independent from the direct influence of any drug company and the topics and presenters could be chosen by the doctors, not the sponsoring company (as is usually the case).

An appropriate CME objective is to obtain as much of your learning as possible from non-partisan and non-promotional sources.