Drug rep visits rarely result in better prescribing, study says

Pharmaceutical promotion through drug rep visits, medical journal advertisements and company-sponsored meetings rarely results in higher-quality prescribing, according to a systematic review published in the October PLoS Medicine.

"The big news here is that many physicians deny that they are influenced by information from pharmaceutical companies, and yet we found many studies where there was an association between promotion and the physician's prescribing," said Dr. Geoffrey Spurling, senior lecturer at the University of Queensland School of Medicine in Brisbane, Australia. "Physicians need to realize that they are not invulnerable to persuasion techniques."

Dr. Spurling and his colleagues evaluated 58 studies, most conducted in the U.S., examining how physicians' prescribing was influenced by drugmakers' promotional techniques. All but one study found that the quality of prescribing -- looking at guideline adherence, effectiveness and safety, among other metrics -- was either unaffected or harmed by pharmaceutical promotion. The studies reviewed found that drugmaker marketing was frequently associated with higher prescribing frequency and costs (link).

Dr. Spurling is a member of Healthy Skepticism, an Australia-based organization that aims to improve health "by reducing harm from inappropriate, misleading or unethical marketing of health products or services, especially misleading pharmaceutical promotion."

The Pharmaceutical Research and Manufacturers of America has consistently said that drug reps provide physicians with critical, timely information about new treatment options.

Dr. Spurling acknowledged that most of the studies were observational and did not look at clinical outcomes, making it difficult to assess the effect on patients. He said randomized controlled trials of drug marketing's effect on prescribing are unlikely to get funded. Even if drug rep visits do not steer a given doctor to write more of that company's drugs, they may not be the best way to fill the gap between patient visits, Dr. Spurling said.

"Pharmaceutical information is also harmful if it wastes physicians' time or resources that could be used to help physicians make evidence-based decisions," he said.