General practitioners who see pharmaceutical sales representatives at least once a week are more likely to prescribe new drugs and to honor patients' requests for prescriptions even if a drug is not the most appropriate, according to new research published in the British Medical Journal.
The journal is devoting its May 31 issue to studying relationships between physicians and pharmaceutical companies in North America and Europe and the effect these relationships have on patient care.
"We hope this will spark a broad debate about how to clean up the unhealthy aspects of the relationships between doctors and drug companies, at the same time as reinforcing the positive collaborations of discovery," says Ray Moynihan, a Washington, D.C.-based journalist who serves as guest editor of the issue.
"But first, drug companies have got to learn how to win friends without having to buy them, and doctors have got to learn to value their profession's credibility without having to sell it," Moynihan says.
After querying 1,097 general practitioners in Britain, British researchers ran their raw data through a statistical model to determine the influence of sales reps on prescribing habits.
"This model found that frequent contact with a drug representative was significantly associated with a greater willingness to prescribe new drugs and to agree to patients' requests to prescribe a drug that is not clinically indicated, dissatisfaction with consultations ending in advice only and receptiveness to drug advertisements and promotional literature from drug companies," British researchers write.
They further say that physicians who have regular dealings with drug reps "are more likely to express views that will lead to unnecessary prescribing than those who have less frequent contact."
Also in the May 31 BMJ is a paper from U.S., Canadian and Brazilian academicians that concludes that that research sponsored by drug companies tends to be biased in favor of the sponsor's products, though studies funded by other sources are more likely to be published.
A Swedish study of "evidence b(i)ased medicine" expands on this theme, suggesting that drug treatment decisions often are based on less-than-objective information because drug companies tend to disseminate studies that cast their products in a favorable light and withhold those that do not.
After examining 42 studies of antidepressants that were submitted to the drug regulatory authority in Sweden, the authors find that "any attempt to recommend a specific selective serotonin reuptake inhibitor from the publicly available data only is likely to be based on biased evidence."
Despite the tone of some of the articles, BMJ editor Richard Smith says the issue is not meant to be an attack on the pharmaceutical industry.
"It does of course take two to entangle, and we hope that nobody will see this theme issue as anti-drug company," Smith says. "Our central argument is that doctors, drug companies and most importantly patients would all benefit from greater distance between doctors and drug companies."