How to get evidence out of a "drug rep"

• "See representatives only by appointment. Choose to see only those whose product interests you and confine the interview to that product
• Take charge of the interview. Do not hear out a rehearsed sales routine but ask directly for the information below
• Request independent published evidence from reputable peer reviewed journals
• Do not look at promotional brochures, which often contain unpublished material, misleading graphs, and selective quotations
• Ignore anecdotal "evidence" such as the fact that a medical celebrity is prescribing the product
• Using the "STEP" acronym, ask for evidence in four specific areas:

• Safety-that is, likelihood of long, term or serious side effects caused by the drug (remember that rare but serious adverse reactions to new drugs may be poorly documented)
• Tolerability, which is best measured by comparing the pooled withdrawal rates between the drug and its most significant competitor
• Efficacy, of which the most relevant dimension is how the product compares with your current favourite
• Price, which should take into account indirect as well as direct costs

• Evaluate the evidence stringently, paying particular attention to the power (sample size) and methodological quality of clinical trials and the use of surrogate end points. Do not accept theoretical arguments in the drug's favour (for example, "longer half life") without direct evidence that this translates into clinical benefit
• Do not accept the newness of a product as an argument for changing to it. Indeed, there are good scientific arguments for doing the opposite
• Decline to try the product through starter packs or by participating in small scale uncontrolled "research" studies
• Record in writing the content of the interview and return to these notes if the rep requests another audience."
  -Greenhalgh (1997)

Greenhalgh T. How to read a paper: the basics of evidence based medicine. BMJ Publishing. London 1997;90-4