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Systematic review: Information from Pharma and prescribing quality, quantity and cost

A major systematic review titled "Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing" by Healthy Skepticism member Geoff Spurling and others has been published by PLoS Medicine.
See the review at:
www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000352
and an editorial titled "Doctors and Drug Companies: Still Cozy after All These Years" by David Henry at:
www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000359

 

The review concludes:

“The limitations of studies reported in the literature mentioned above mean that we are unable to reach any definitive conclusions about the degree to which information from pharmaceutical companies increases, decreases, or has no effect on the frequency, cost, or quality of prescribing. In theory, advertising may be beneficial in several ways: by distributing information and thus improving the quality of prescribing, by reducing costs through increasing price-elasticity, by increasing prescribing of drugs that provide better health outcomes, or by improving the cost-effective use of healthcare resources. Because of the limitations of both the included studies and this review we have not disproved those theories but we have found little evidence to support them and have found some evidence of increased costs and decreased quality of prescribing. Any conclusions about harm or benefit for patients are speculative because none of the studies that we found examined clinical outcomes. One clear conclusion from this review is that we did not find evidence of net improvements in prescribing associated with exposure to information from pharmaceutical companies.

Some argue that prescribers have an ethical duty to avoid exposure to pharmaceutical promotion. Even ineffective promotional information may be harmful if it wastes prescribers’ time or if the money spent on promotion increases the cost of medicines; this is of concern given the large expenditure involved. In the absence of evidence of net improvement in prescribing from exposure to promotional information, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies unless evidence of net benefit emerges.”

The editorial concludes:

“Sometimes we are forced to draw conclusions and take actions even when the supporting evidence is of a low level, as it is here. When assessing a body of evidence for harm we have to consider a number of factors, including the magnitude of the effect and the quality of the research behind the claims. But there are other dimensions, including the potential benefits of the activities and the availability of alternatives (in this case other sources of information on new pharmaceutical products). These questions, normally applied to treatments, may sit uncomfortably in a political economy where private companies have the right, indeed the obligation, to market their products effectively to health professionals.

But if industry promotional activities influence the treatments that patients receive, we should ask for evidence of benefit. If that benefit is better knowledge and more effective and safer use of medications, and commercial promotion is better at doing this than publicly funded drug information, we should be prepared to tolerate some adverse effects. If the benefits are slight, or absent, then we should have a low tolerance for any adverse effects. Spurling and colleagues may have difficulty demonstrating a strong evidentiary base for claims of harm from industry promotion, but they have done an effective job of excluding any important benefit from this relationship.”

 

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