Physician exposure to drug company promotions can cause their patients physical and financial suffering and provides no benefits to their prescribing practices, a York University study shows.
And yet multibillion-dollar efforts by pharmaceutical giants to get doctors to prescribe their products add 10 to 20 per cent to Canada’s annual drug costs, the study suggests.
“It’s difficult . . . after looking at all this evidence, to argue that there’s any reason why doctors should expose themselves to (drug) promotion,” says Dr. Joel Lexchin, a paper co-author.
“There isn’t any reason why they should read the ads in the medical journals or see the sales representatives who come to their offices,” says Lexchin, of York’s School of Health Policy and Management.
The study, which looked at some 58 international papers on drug promotion published over half a century, was released Tuesday by the online journal PloS Medicine.
It found that exposure to pharmaceutical promotions often increased the amount of medications physicians prescribed, made them choose more costly drugs and could lead them to write unnecessary prescriptions.
“Prescribing did not get better, prescribing did not get less expensive and prescribing did not get less frequent,” Lexchin says.
“Either things got worse after being exposed to the promotion or they didn’t change at all.”
Lexchin says drug promotions typically tout the most expensive medications available and do not present cheaper or equally effective options.
“And if you’re getting a drug when you don’t need it, you have the possibility of suffering side effects from that product,” he says.
Lexchin says pharmaceutical sales representatives often offer doctors free meals and items for their practices, like textbooks and anatomical aids, during office visits.
“But for the most part, this is not a bribe kind of relationship,” Lexchin says.
“By seeing sales representatives, by getting to be friendly with them, this sets up a relationship whereby doctors view sales representatives not as sales people but as friends.”
Lexchin estimates pharmaceutical companies spend between $2.4 billion and $4.8 billion a year promoting their products in Canada, most of that aimed directly at doctors.
These costs are passed on in higher prices to patients, insurance companies and government drug programs.
That represents between 10 and 20 per cent of the country’s annual $25-billion drug bill, Lexchin says.
Steve Morgan, a University of British Columbia pharmaceutical industry expert, says the study shows that little has changed over the past decades in the problems associated with drug promotion.
“Sometimes, as this review shows, that will mean the doctor will prescribe more often and sometimes it means the doctor will prescribe (a promoted) drug rather than potential alternatives,” says Morgan, a Canadian Institutes of Health Research economist.