“Why don’t you see Drug Reps?” This was the question posed to me a few years ago when I attended an educational meeting at our local post-graduate centre. I was collared trying to get past the stands of promotional glossy brochures and free gifts by a new representative to our area. I muttered something about not finding the information that reps gave very useful to me, and he retorted that his company had just released a new tablet for diabetes. “The results were very encouraging”, he said, and “I was sure to hear more about it soon”.
I did. A few months later the drug in question was withdrawn because it caused unexpected serious liver problems in some patients.
Last week saw the voluntary suspension of another Cox-2 inhibitor, valdecoxib (Bextra) by Pfizer. The memo from Professor Duff at the Committee of Safety of Medicines states that “valdecoxib is associated with a higher rate of serious, potentially fatal skin reactions, …… ,in addition to the established class evidence of cardiovascular risk with selective COX-2 inhibitors.”
It has been our policy not to see drug reps in the practice for the past 20 years, and I think if I was asked today why we do not see drug reps, I would use the COX-2 story as a good example. The BMJ theme issue in May 2003 included several papers on this topic, including a cross-sectional survey that showed an association between frequent contact with a drug representative and greater willingness to prescribe new drugs(1).
This is hardly earth-shattering news – pharmaceutical companies would not continue to invest in their representatives if they did not boost the sales of their newest products. The same BMJ issue also contains a reference to a confidential survey of 117 junior hospital doctors in the USA(2). Of the 117 who were sent the survey an impressive 105 replied. They describe an interesting perceived personal impermeability to the influences of the pharmaceutical industry: “Most respondents (61%) stated that industry promotions and contacts did not influence their own prescribing, but only 16% believed other physicians were similarly unaffected.”
So why do you see drug reps? Isn’t it better to obtain information on new drugs from parties who do not have such a vested interest in them? I will continue to wait for assessments in the Drugs and Therapeutics Bulletin before rushing to prescribe the latest drugs on the market.
In the next newsletter I will reflect on the recently published House of Commons Health Committee report “The Influence of the Pharmaceutical Industry”(3). It makes fascinating reading, particularly in relation to the recent problems with SSRI and COX-2 inhibitors, and the hidden ways in which the industry seeks to increase the sales of its products. It is available free online athttp://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf I will just have to finish reading it first!
1.Watkins C, Moore L, Harvey I, Carthy P, Robinson E, Brawn R. Characteristics of general practitioners who frequently see drug industry representatives: national cross sectional study. BMJ 2003;326(7400):1178-1179.
2.Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 2001;110(7):551-7.
3.HouseofCommonsHealthCommittee. The Influence of the Pharmaceutical Industry. London: The Stationery Office Ltd; 2005.