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Healthy Skepticism International News

October 2007

A response to Tiago Villanueva

By Geoffrey Spurling, Senior Lecturer, Discipline of General Practice, University of Queensland, Australia

Patient health is what all GP registrars/ trainees are striving to improve when they embark on the arduous process of becoming competent GPs.

Having a fully funded government GP training program free of commercial influence was one of the many great blessings of practising medicine in Australia. Tiago Villanueva appears not to have had this benefit in Portugal. At a vulnerable time in his training, he seeks to fill the educational void with the pharmaceutical industry. I am sure this would seem to be the most convenient option in the absence of reasonable alternatives. The pharmaceutical industry here would be deliriously happy to have the opportunity to have such a degree of influence on the newly forming management and prescribing decisions of GP trainees which will last with them a lifetime.

It sounds like the pharmaceutical industry likes the situation in Portugal. It is not clear why the government maintains the status quo. Perhaps it doesn’t care as they don’t have to spend the money. Perhaps they are lobbied hard by the industry to stay out of GP training.

What does this educational process mean for GP trainees and Portugal in general? There are no drug reps who will come and tell you not to prescribe, there will be none who emphasize diet or exercise and none who emphasize Cognitive Behaviour Therapy – they are not profitable. There are countless other examples like this.

What the evidence tells us is that the information doctors receive from pharmaceutical companies omits important safety information, promotes increased prescribing, increases costs of prescribing and results in less rational prescribing. These outcomes are not desirable for the GP trainee and are certainly not ideal for Portuguese patients. The Portuguese government’s decision to not actively fund GP registrar training is also not in the interest of Portugual overall. The country will have to pay more for prescription drugs, and there will be more unnecessary prescribing. Less rational prescribing will result in patient injury, increased hospital admissions and stays. Thses problems will persist for generations as further cohorts of GP trainees are influenced by drug reps. These costs listed above are likely to be much greater for the country than the price of funding adequate GP training.

Tiago Villanueva clearly feels conflicted about the role of pharmaceutical company influence on the rest of his career and he is right feel concerned. Rather than acquiescing uncomfortably, his patients would gain more benefit if he abstained from information from pharmaceutical representatives, gained skills in learning through evidence-based methods (using information that is open access on the internet or available from his local medical library) and got a group of fellow trainees together to lobby the government to provide training. Healthy Skepticism will be keen to help as best we can.

As Tiago’s email trailer says: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” - Margaret Mead, American cultural anthropologist.



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