The majority of family doctors receive little or no information about harmful effects of medicines when visited by drug company representatives, according to an international study involving Canadian, U.S. and French physicians.
Yet the same doctors indicated that they were likely to start prescribing these drugs, consistent with previous research that shows prescribing behaviour is influenced by pharmaceutical promotion.
The study, which had doctors fill out questionnaires about each promoted medicine following sales visits, was published online today in the Journal of General Internal Medicine. It shows that sales representatives failed to provide any information about common or serious side effects and the type of patients who should not use the medicine in 59 per cent of the promotions. In Vancouver and Montreal, no potential harms were mentioned for 66 per cent of promoted medicines.
"Laws in all three countries require sales representatives to provide information on harm as well as benefits," says lead author Barbara Mintzes of the University of British Columbia. "But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion."
Serious risks were mentioned in only six percent of the promotions, even though 57 per cent of the medications involved in these visits came with US Food and Drug Administration "black box" or Health Canada boxed warnings - the strongest drug warning that can be issued by both countries.
"We are very concerned that doctors and patients are left in the dark and patient safety may be compromised," says Mintzes, an expert on drug advertising in UBC's School of Population and Public Health.
Doctors in Toulouse were more likely to be told of a harmful effect in a promotional visit, compared to doctors in Canada and the U.S., according to the study. Researchers suggested that this may reflect stricter regulatory standards for promotion of medicines in France.
NB: Figures showing the study's key findings are available at
BACKGROUND | DRUG SALES VISITS LACK DETAILS
About the study
The UBC-led study is the most comprehensive to date of the quality of pharmaceutical sales representative promotions to family physicians.
Researchers recruited physicians to participate using random samples from lists of primary care physicians at four sites - Vancouver, Montreal, Sacramento and Toulouse. Among 704 eligible physicians contacted, 255 (36 per cent) chose to participate. Information was collected on 1,692 drug promotions at sales visits between May 2009 to June 2010.
Doctors were asked to fill out a questionnaire about the information provided for each promoted medicine following each visit they received from pharmaceutical sales representatives. Sales representatives regularly visit doctors' offices to promote medicines by providing information, free samples and in some cases food and invitations to events. The study focused on how often information was provided about drug safety.
The team includes researchers from UBC, York University, University of Montreal, University of California, Davis and the University of Toulouse.
Dr. Tom Perry, an internal medicine and clinical pharmacology specialist at the UBC Hospital in Vancouver, who is not part of the study, expressed concern about the findings:
"Doctors learn relatively little about drugs in medical school, and much of their exposure to pharmacology after graduation may be in the form of advertising. If they are unaware of the potential harms from drugs they prescribe, patients inevitably suffer the consequences."
Perry also called for much stricter control of drug advertising in Canada.
Dr. Perry can be reached by pager 604-707-1427 or e-mail firstname.lastname@example.org.
Prof. Barbara Mintzes
UBC School of Population and Public Health
UBC Public Affairs