Healthy Skepticism Library item: 2003

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

Becel B, Bardelay D
A french physician's network monitoring medical representatives
Prescrire 1997 Jun

Full text:

Since 1991, an anonymous network of general practitioners and a small number of hospital pharmacists, readers of the independent French drug bulletin La revue Prescrire has been monitoring the behaviour of medical representatives of pharmaceutical companies and the accuracy of their claims and the information they provide.

After each visit by a medical representative, members of the network fill in a standard report form, noting if the information given orally on indications and dose regimen of the drug differ from the official data sheet. They also report whether the representative spontaneously mentioned side-effects, contra-indications and interactions, as well as the particular arguments used to encourage prescribing of the drug (including gifts and paid participation in clinical trials).

An assessment of the results over the period 1991 – February 1997 show the following. Overall, the drugs’ indications were extended or changed in about 27% of the visits, and dose regimens were not in accord with the data sheet in 15%. More seriously still, side-effects, contraindications and interactions were not mentioned in 76% of the visits. Qualitative evaluation showed that off-licence information was based on either premature claims, analogies with other drugs, or pure promotional fantasy.

The following measures were intended to minimise bias: names of the monitoring doctors were kept secret, doctors were replaced every six months, the participating doctors were distributed in 16 out of the 22 French regions.

The main bias probably lay in the selection of the monitoring practitioners, who volunteered out of interest in rational drug use. The representatives may have therefore been more likely to offer them more scientific evidence and avoid incentives. This would tend to bias the result towards presenting an over-optimistic view of the reality.

During the period, 1991 – February 1997, the findings have been remarkably consistent. The figures show no sign of improvement which is a reason for concern. In the period 1995-1996 there was a slight improvement in the quality of the information provided by the medical representatives on indications and dose regimen. Unfortunately this improvement turned out to be a temporary trend. In the course of 1996 – February 1997 the figures show again a weakening of the quality of the information. The monitoring network is an ongoing activity and updated figures on the results are presented regularly in La revue Prescrire and Prescrire International.

For more details see Prescrire International vol. 4 no 18p. 120-122.

Why do Practitioners Join the Reps Monitoring Network?

The doctors and pharmacists who want to join the reps monitoring network are asked to write a letter in which they explain their motivation and to fill in a questionnaire. This questionnaire is designed to ensure that no participants ‘planted’ by the pharmaceutical industry enter the network.

1- Those who are shocked by what they hear during the visits from medical representatives:

“I hear too many stupidities. I want to be able to report on the discrepancies (…)”

Ï am shocked by what I hear and tried to be treated like an ignorant person (…)”

…“I want to stand up against the pressure, the intellectual dishonesty and the distain for public interest some pharmaceutical industries display (…)” etc.