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Healthy Skepticism Library item: 18819

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: news

Blackwell T
Blackwell on Health: Is Pharma influencing doctors’ prescriptions?
National Post 2010 Nov 1

Full text:

Like any industry, the pharmaceutical business uses marketing to gain the highest-possible sales for its goods. Unlike most other industries, those efforts are fraught with ethical, medical and economic issues. After all, these are products like no other, having the potential to do incredible good, or great harm. And they cost us: prescription medicines are the-second fastest growing part of our health costs. Now a new study in the journal PLoS Medicine has offered more evidence that when Big Pharma tries to exert its influence on doctors, the results are not always for the best.

The authors are mostly Australian but also include Dr. Joel Lexchin, an emergency physician and York University health-policy professor. Most are part of a group called Healthy Skepticism, whose mission is to highlight misleading health information. Dr. Lexchin is a well-known critic of pharmaceutical marketing. The researchers analysed 58 studies from the 1960s on that looked at the impact on the quality and quantity of doctors’ precribing when exposed to information from the industry. The results, though less than conclusive, were sobering.

Of the 10 that examined quality, five found links between pharma information and lesser-calibre prescribing, four found no connection and one identified both lower and higher-quality prescribing. There were 38 studies that found an association between industry information and doctors prescribing more drugs and 13 that did not. Five studies cited evidence of higher costs as a result of pharma influence on doctors, one lower cost and one found no cost association.

All of the studies were observational – they simply looked at what doctors did rather than set up a trial that randomly selected doctors to receive industry information and compared them to those who did not. Nor did any of the studies investigate the actual outcomes on patients. The journal editors say the evidence cannot definitively rule out that marketing actually has positive benefits, like keeping doctors better informed. But they say it’s strong enough to support unspecified reforms of pharmaceutical promotion. The authors go further, suggesting that physicians ignore marketing information:

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.


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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963