28 July 2006

Comments on my piece on regulating drug promotion

I thank Dr Ken Harvey very much for his comments, which you can read here (I haven't been able to figure out how to get Blogger to post comments with the original). I would also urge readers to follow some of the links Ken has provided and check out the evidence for themslves.

If you read my piece carefully, I don't actually argue that doctors are not influenced by the promotional activities of pharmaceutical companies. Of course, they are also influenced by their cultural backgrounds and religious beliefs, what medical school they went to, their patients, what they read in the newspapers as well as in the medical journals, what their colleagues tell them in the tea-room (evidence-based or not!), and whether they had time for breakfast and have had that all-important first cup of coffee yet (sponsored or not!). But I don't hear people clamouring for the ACCC to investigate the effects of each of these - and their interactive effects - on prescribing behaviour.

In the course of interviewing hundreds of GPs and specialists about influences on their clinical decision-making, I have been utterly flabbergasted at some prescribing practices that clearly owe nothing to company promotion (let alone any sort of logic). Of course doctors deny that they are influenced by promotion - from Federal Court judges and competition commissioners to mug punters at the local TAB, we all like to think of ourselves as rational decision-makers, but it's just not the case. But I've seen numerous product managers squirm when they hear the news that doctors can't recall the quirky brand name, thought it was only approved for a different indication, still prescribe the old one out of habit, etc. etc.

Anyway, I don't argue that there is no influence. But I will continue to argue most strenuously with those who make a giant non sequitur, leaping from the question of influence to the conclusion that this harms patients or community health or welfare. For example, the ACA says sales reps should be externally regulated because “representatives attempt to influence doctors’ prescribing patterns in non-rational ways which have negative outcomes for consumers”. This single, unreferenced, sentence paints the sales rep as deceptive, the doctor as potentially irrational and the consumer as unwitting victim. The Medicines Australia code mandates reference support for claims about drugs, but there is clearly no such code for the ideologue!

And speaking of influence, consider some of the incredibly emotive language used by Graeme Samuel in his opinion piece in today's Melbourne Age. At first, he reserves judgement and concentrates on transparency: "Regardless of whether such largesse actually influences a doctor or not... the perception of influence is enough". But, just when we think he's keeping an open mind, CLANG! the cell door closes: "Doctors prescribing medication based on anything other than the patient's needs offends the morals" and these are "grubby issues" and "an unpleasant stain" (presumably the remains of one of the "lavish dinners" at "top-class restaurants"). In other words, we’re not saying it happens, but it’s disgusting and we’re going to act anyway!

Finally, while we're on the subject of the difference between rational and emotional persuasive appeals, both Ken Harvey and the ACA played "the tobacco card" in their submissions to the ACCC. The ACA actually said "a parallel can be drawn between the methods employed by the pharmaceutical industry now and those that were employed by the tobacco industry" - you can read this outrageous quote for yourself here.

1 comment:

Dr. Ken Harvey said...

It seems that more people are, "playing the tobacco card"; perhaps there is something in this, "social determinants of health" stuff?

VicHealth chief executive Rob Moodie said yesterday the actions of pharmaceutical companies trying to promote their drugs has contributed to the rising cost of health care.

Drug companies, he said, were extremely influential, continually putting pressure on governments. The relationship between drug companies and government should be more transparent, Dr Moodie said.

"We just have to make better judgements about how we spend the health dollar and be more resistant to the lobbying of the drug companies," he said.

Dr Moodie said drug companies spent far more on the promotion of drugs than actual research and development. There should be a greater focus on prescribing more cost-effective generic drugs.

He also raised concerns about the ethical conduct of some companies.

"There are many, many instances of inappropriate promotion of pharmaceuticals and, therefore, inappropriate expenditure," he said. "I don't deny them their right to make an ethical dollar … it's just a question of operating in a fair, ethical and reasonable way."

A Medicines Australia spokesman said the group would welcome the opportunity to discuss these issues with him.

Dr Moodie will present a paper at a national health-policy meeting today. In the paper, he argues that industries, including pharmaceuticals, food and alcohol, had "enormous power and influence". If they disagreed with public health approaches, they could use their lobbying capacity with presidents and prime ministers, treasurers and ministers.

Dr Moodie also said the alcohol industry continually flouted its own advertising code, and self-regulation was not working. He said inappropriate advertising of unhealthy products was one of the biggest threats to public health.

"Whether that's tobacco, or encouraging kids to over-consume alcohol, whether it's over-promoting fast food and high-energy dense drinks, it's not a level playing field for rational choice, particularly for children," he said. From:
http://www.theage.com.au/news/national/ama-chief-admits-professions-reputation-at-stake/2006/08/07/1154802820479.html