Healthy Skepticism Library item: 15073

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Publication type: news

Blackwell T.
Ontario aims to counter drug firm sales pitches
National Post 2009 Jan 29
http://www.canadapharmacynews.com/2009_02_01_archive.html

Full text:

Hoping to counter the influence of pharmaceutical-company representatives and their well-versed sales pitches, the Ontario government is joining a growing national movement to offer physicians one-on-one drug briefings that leave out the commercial bias.

Research suggests that visits by pharmaceutical reps, the heart of a multi-million-dollar marketing system, can inordinately skew doctors’ prescribing habits.

The province is planning to fund independent experts to visit medical offices and offer a balanced, evidence-based take on drug treatment.

The advice from the proposed service should lead to more appropriate treatments being prescribed to patients, the Ministry of Health says.

It is also hoped to lower costs for the government drug plan.

Its action follows on the heels of a similar initiative getting underway in B.C. Other provinces, from Saskatchewan to Nova Scotia, have also dabbled in the idea, called “academic detailing,” though the Ontario venture promises to be the largest one yet.

“It’s going to be a province-wide program to reach out to as many doctors as possible, to provide expert advice and independent review of drugs and classes of drugs,” Andrew Morrison, a ministry spokesman, said.

The province issued a tender this month for a contractor to set up an academic detailing program by late spring.

Drug costs have soared 140% since 1997, accounting for an increasingly large chunk of health spending, and actions by the industry – along with factors such as the ageing population — have played a “significant role” in that inflation, the provincial contracting papers say.

Detailing was originally an industry term, referring to regular visits where reps, armed with the latest research, outlined their drugs’ specifications to doctors. “Academic detailing provides balanced messages in the face of perceived commercial influence of pharmaceutical company detailing,” the Ontario government documents say.

The idea is to co-opt a model — personal visits to doctors in their own offices — the industry showed was very effective, said Dr. Joel Lexchin, a health-policy expert at Toronto’s York University.

The Canadian drug business has curbed the wining and dining of physicians that used to go hand in hand with those visits, but the reps and their ability to win physicians’ trust still have a significant impact, he argued.

“It’s that relationship that influences prescribing behaviour,” said Dr. Lexchin, who is also an emergency physician.

And the company emissaries often promote their employers’ newest products, which tend to be the most expensive, may have little advantage over older drugs and lack the fullest safety evidence, he said.

A U.S. study published in the journal PLoS Medicine in 2007 found that almost half the doctors who received brief visits from drug reps to promote an epilepsy drug said they would prescribe the medicine more or recommend it to colleagues. An article in the same journal outlined techniques representatives employ to foster close relationships with doctors, such as scouring offices for objects — like novels or sports equipment — that could be clues to forging a personal bond.

The industry, however, says its representatives simply keep doctors informed, which is to everyone’s benefit. Those “health information specialists” pass on evidence-based data on drugs, and are governed by strict ethical rules in their dealings with physicians, said Russell Williams, president of Canada’s Research-based Pharmaceutical Companies.

“Our efforts are designed to get the best possible outcomes for patients and this will remain our priority,” he said.

As a pioneer in academic detailing, Nova Scotia has two pharmacists and a nurse who visit the doctors willing to see them – about 60% of the total – two or three times a year.

They give short talks on treatment of specific conditions, such as chronic pulmonary disease, or classes of drugs, such as the proton-pump inhibitors used to combat heartburn, said Dr. Michael Allen, the Dalhousie University medical professor who heads the program.

The detailers impart a balanced overview of available treatments and encourage doctors to look deeply into the evidence around a drug, he said. For instance, a study might suggest a therapy cuts the risk of heart attack by 50% among certain patients, but if the rate of attacks is very small to begin with, that can mean the drug benefits only a tiny percentage of people, Dr. Allen said.

The presentations are based on research that individual doctors would be hard-pressed to conduct on their own, he said.

“They don’t have time,” Dr. Allen said. “It takes us hours and hours, it takes us months to get something ready…. Doctors are too busy being doctors and seeing patients.”

Alberta, Manitoba, Saskatchewan and B.C. have programs of varying sizes, but the concept is generally underfunded, leaving the academic and industry detailers in a “David and Goliath” situation, Dr. Allen said.

Dr. Lexchin said he hopes the Ontario service is administered at arm’s-length, not by the province itself. If doctors perceive the detailers to be government officials, they will assume the exercise is all about reducing drug costs and ignore their advice, he warned.