(2004; 102 pages)
1.6 What do health professionals think about the quality of the information provided by sales representatives and advertisements about drugs?
Thirty-two per cent of the psychiatry trainees surveyed by Hodges agreed that sales representatives provide useful and accurate information on new drugs (25% for established drugs)4. Fifty-eight per cent of family medicine residents in Sergeant et al.’s study5 felt that the literature provided by sales representatives was useful.
Ninety-two per cent of the Canadian doctors surveyed by Strang et al.13 felt that sales representatives had product promotion as their major goal, and 80% felt they over-emphasised medicines' effectiveness. Forty-seven per cent of the doctors in Eaton and Parish’s study19 felt that they were not able to obtain an unbiased assessment of a newly introduced drug. Most of them felt that most drug information was too commercial and therefore biased.
In a New Zealand study, Thomson et al.20 found that 58 out of a sample of 67 doctors saw sales representatives. In response to an open-ended question about why, 56 of them gave a reason related to learning about new or existing products. The director of the Pharmaceutical Manufacturers’ Association of New Zealand described a survey of doctors, in a letter to the editor of the New Zealand Medical Journal21. Without giving methodological details, he claimed that most New Zealand doctors felt that sales representatives are a good source of information about drugs and recognise practitioners’ information needs, but are over-biased towards their own products.
In contrast, only 16% of UK GPs surveyed by Hayes et al. found visits by sales representatives to be educationally valuable18. University and community practice doctors surveyed by Shearer et al.22 rated direct mail, journal advertising and detailers as the three least reliable sources of drug information. Doctors in community hospitals ranked the representatives they saw higher than university hospital doctors ranked those reps whom they saw. Whelan et al.23 report that staff members in a family medicine residency training programme in Canada did not rate sales representatives as a very useful source of information in response to drug information questions. They rated them poorly on all aspects: frequency of use, availability, ease of use, understandability, helpfulness, extensiveness, and how much confidence they had in them. Among Cockerill and Williams’ Ontario pharmacists24, a minority of the respondents (25%) said sales representatives were an important source of information, while only 17% thought advertisements and promotional literature were. Drug sales representatives were never mentioned as sources of information for the complex clinical case studies used by Boerkamp et al.25. The majority of psychiatrists shown advertisements for psychotropics by Lion et al.26 did not find them attractive or informative.
Sixty-eight per cent of doctors working in a Turkish city surveyed by Güldal and Semin27 thought the information provided by representatives was unreliable. Ninety-four per cent felt a reliable source of information about drugs, other than pharmaceutical companies, was needed.
Benseman28 found that the 45 New Zealand doctors he surveyed expressed varying degrees of anger and frustration at the waste involved in the material they were sent by drug companies. Almost all felt that company material was biased and should not be taken at face value. However they preferred drug company sponsored journals to academic journals, because they found them more relevant to general practice.
Mackowiak et al.29 surveyed a small convenience sample of US community pharmacists and a small sample of pharmacy students about advertisements for over-the-counter drugs in pharmacy journals. In the USA, advertisements for over-the-counter medicines are regulated by the Federal Trade Commission. They must be truthful and not misleading. This is a lower standard than that enforced for prescription drugs. Around half the pharmacists, and students, surveyed by Mackowiak regarded the advertisements they were shown as misleading and not truthful. However they also reported high levels of reliance on them. Most respondents (90% of pharmacists and 81% of students) thought regulations for over-the-counter products should be the same as prescription products.
In a study of health care providers in Africa30, commissioned by the International Federation of Pharmaceutical Manufacturers Associations and the US Pharmaceutical Manufacturers’ Association, 95% of those who received company-provided information reported finding it helpful. The design of this study is not well described.
CONCLUSION: Doctors’ opinions on the usefulness of information from drug companies vary but most believe that such information is biased.