The car buying process involved a lots of research, a bit of procrastination and then some negotiation.
Reading several months of Wheels, Top Gear & Car & Driver
Like reading the MJA/BMJ/NEJM
Reading Carsguide & Caradvice websites
The 6 Minute and Australian Doctor equivalent
Watched Youtube reviews and forums like VW Watercooled Australia to get the gossip on reliability and after sales service
Not sure if there is any medical equivalent, maybe GPDU
Then I did talk with a salesperson
The Drug Rep
And went for test drive
No real equivalent experience here. It isn’t really appropriate to ask for a sample of Targin to see how it helps my chronic pain, or shoot up Saxenda for a month to see if I loose weight.
So should I use drug reps as my primary source of information about new drugs?
Should I even see drug reps?
Dr Brett Montgomery has written on the subject here https://theconversation.com/why-i-dont-see-drug-reps-a-gps-take-on-big-pharma-spruiking-32435
Dr Ben Goldacre has blogged on his BadScience website and written on the influence of pharmaceutical companies on drug utilisation. After eventually making it through Bad Pharma I felt a little pessimistic about the whole process. It’s a bit like House of God, essential junior doctor reading.
A list of problems include
- Missing clinical data which the rep probably doesn’t know about either
- Positive paper publication bias
- Ghost writers instead of academics
- No decent independent head to head studies, so what if me2 is better than placebo is it better than the first drug?
- Kick backs to medical journals
- Half blind public agencies
- Statistical manipulations and sub- subgroups analysis
- Glossed over serious adverse effects. “The risk of thyroid cancer with Saxenda is over rated!” or “No that only happens in beagles”
- Glossy brochures and advertising in journals.
- Pushy drug reps and their inducements – which do seem limited to lunch rather than international flights these days.
- Leaving behind drug samples as starter packs
- Subsidising patients support groups and turning them into pharmaceutical lobby groups
- Product familiarisation campaigns
- Breaking news on popular media dressed up as “news” stories
- Chatting in the ear of the clinic nurses, who also look after the sample cupboard. I wonder if any rep has suggested that the oppositions product be pushed to the back or even in the bin?
- Paying specialists to “educate” GPs
- Creating a “disease” to sell a product, eg fibanserin for a woman’s poor libido
As a health professional am I impervious to drug rep propaganda. I think the evidence suggests NO.
A few hints include the average sales force expenditure for pharmaceutical companies is $875 million annually and that is just in the USA. Being Australian, I am of course more skeptical and cynical but even so it has been estimated that in 2012 $30 million was spent by pharmaceutical companies trying to persuade doctors to use their product. I think it safe to assume no one would spend that kind of money if there wasn’t some return.
I think I can say that drug are not evil and may be a source of information but they need to handled with care.