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Drug companies have always courted physicians, who are the gatekeepers to the consumption of their product. They play a key role in pharmaceutical practice and management. After all, as developer and sponsor of the product, the company knows more about the drug than anybody else.
The amount of money spent by drug makers on promotional efforts has increased from $9 billion in 1996 to $25.3 billion in 2003. A considerable amount of that sum was spent on direct-to-consumer advertising, such as slick television commercials intended to pique interest and demand for products.
In years past, drug companies lavished gifts upon physicians, ostensibly to generate goodwill but also in the hopes that when the clinician is in a position to prescribe he or she will think of their product first.
Many of the excesses were reined in by a voluntary code adopted by the Pharmaceutical Research and Manufacturers of America (PhRMA) in 2002 to govern relationships between industry and health care professionals. Under the new code, interactions between drug makers and physicians are intended to benefit patients and enhance the practice of medicine. The goals are to inform providers about the benefits and risks of products, provide scientific and educational information, support medical research and education, and obtain feedback and advice about their products.
Still, drug companies try every avenue possible to get the physician's attention. Drug reps ply office practices with pens, pads, clips, and other swag to keep their product's name prominent. At exhibit halls, attendees are tempted with food and coffee while reps helpfully offer to answer questions or provide information. So we asked attendees at November's North American Association for the Study of Obesity (NAASO) Annual Meeting in Las Vegas:
Some research suggests that physicians may be influenced inappropriately by drug advertising. How do you think advertising affects your prescribing habits?
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We'd be naïve to think that it doesn't have an effect. Just seeing the name brings certain things to mind. Having signs around and pens and products, it gets the word out there, and I think it does affect prescribing patterns. Whether it causes detriment to the patient, I don't know.
In some cases, [physicians] aren't keeping up with the literature, and that can have a detrimental effect.
Bradley Eilerman, MD
Internal Medicine/Pediatrics
University of
Cincinnati
Cincinnati, Ohio
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I imagine advertising does affect me. The studies all show that individual doctors believe that it doesn't influence them, but it influences everybody else. I think we know that the drug companies have research that shows what they're doing influences people. So we probably are all [affected], in good and bad ways.
What advertising does is distort choices in a competitive part of the marketplace. But on the other hand, it makes people aware of the existence of drugs and therapeutic alternatives that they may not otherwise be aware of.
Charles Billington, MD
Endocrinology
Minnesota Obesity
Center
Minneapolis, Minn.
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Drug reps sponsor all these things; you go and listen to them. At a training hospital, a medical center, a drug rep's influence is less so, where [physicians] are more up on the current literature and they tend to look at all sides before making a decision about medication.
On an individual basis, if you look at the data out there, it shows that there's an influence. I think it's not necessarily a bad thing, in the sense that if you're out of an academic environment in a private practice a long time, drug reps do offer an educational opportunity. It's incumbent on physicians to determine whether it's good data before making a decision on prescribing.
Does advertising make a difference? Yes it does. It's been proven that drug companies influence physicians' prescribing methods. But how much difference does it make? That's an individual thing. A doctor has to make his or her own decisions.
Steve Chen, MD
Internal Medicine
UCLA Center for Human
Nutrition
Los Angeles, Calif.
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I feel that, unfortunately, people get influenced. We are human beings. As doctors we're supposed to have unbiased opinions about medical interventions; the treatment of obesity, diabetes, or anything. Particularly in obesity, we are too prone to follow the first line of evidence, which is sometimes not completely peer-reviewed, about the choice of drug in obesity.
My opinion is that, if we implement preventive measures, we don't have to go to drugs, which are a last-case scenario. Our obligation is to teach people about diet and exercise, and then make a really well-informed opinion about the use of drugs. We see an advertisement, and we think maybe it's true. When we don't have good references about the pharmacological approach, we are lost.
Margarita Teran-Garcia, MD, PhD
Post-doctoral Fellow, Human
Genomics
Louisiana State University
Baton Rouge, La.
TALK BACK: DRUG IMPORTS
Increasing numbers of Americans are doing an end run around the U.S. drug industry by buying their prescription medications from sources in Canada or Mexico.
Drugs imported from Canada or Mexico cost 30% to 50% less than the same drugs sold in the U.S., leading many Americans to search the web for mail order sites and go on cross-border drug-buying bus trips.
At least 20 states have sought permission from the Food and Drug Administration (FDA) to circumvent the U.S. market and import drugs from foreign pharmacies.
FDA has taken the official position that safety and purity of imported drugs cannot be assured, opening the door for counterfeits and dangerous drugs. Drug importation is also opposed by the Pharmaceutical Research and Manufacturers of America (PhRMA) and pharmacy trade groups.
Opponents of drug importation say the products could be ineffective or toxic and aren't subject to the strict regulatory review as in the U.S. Proponents contend that drugs are imported from legitimate, licensed pharmacies located in other countries and can be purchased with confidence.
What do you think? Is importation of prescription medication right for your patients?
Send your comments to docnews{at}diabetes.org.
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