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Why should drug promotion be different than car promotion?

Because doctors are not salespeople

Based on the Congressional testimony of  Michael Wilkes, M.D., Ph.D. Vice Dean, Medical Education Professor of Medicine and Public Health, University of California, Davis in front of the Committee on Government Reform with respect to safety of Vioxx.

When a bright person decides to purchase a car they shop around, they read Consumer’s Report, and they talk to the car salesmen. The consumer decides what size engine, what color, and what model they want. Short of lying or being fraudulent the car saleswoman is there to sell cars and the buyer must beware. No one expects a car salesman to act in the public’s interest – they are only there to sell cars.

As a profession, medicine is profoundly different. We have a covenant with society to act in society’s best interest. Doctors go to school for years to learn their science. And we use that science for the public’s benefit. We interpret and explain the risks and benefits of a treatment so that a sick person can decide what course of action they wish to take. The patient needs the doctor solidly in their corner.

In exchange for all this hard work and for acting selflessly, doctors are given lots of privileges. Doctors are paid handsomely, they have all the rights of a profession including deciding who gets in to the profession and who can call themselves doctors.  But once we let our own self-interest get in the way we break our covenant with society and we invite public outrage and oversight. All these gifts, trips, tickets, and lunches have compromised the public’s trust.

How accurate is the information provided by Pharma to doctors?



First, one has to decide what standard should be applied to promotional information. If they are “just ads”, then perhaps they should be held to no higher standard than the promotional material for Volvos, Coke, or Crest toothpaste. If, as is maintained by Pharma, their material is “educational” then their ads need to be held to the high standards of educational material that usually includes peer review, high factual accuracy, and clarity.

In fact, promotional material is not meeting these standards. As Former FDA Commissioner Kessler described, “…enormous potential exists for misleading advertisements to reach the physician and influence prescribing decisions…misleading advertisements can result in significant adverse consequences…needless injury or even death may occur because physicians have been persuaded to prescribe products for uses for which they have not been adequately tested or to substitute therapies that may be less safe or less effective than the alternatives."

Stryer and Bero showed that much information (42%) failed to comply with one or more FDA regulation including 35%, which lacked fair balance between risks and benefits.  My research has shown that 40% of print ads in medical journals did not present fair balance, 58% contained images that expert reviewers felt minimized concerns about side effects, and that 47% of the ads did not appropriately highlight risks and contraindications in special populations such as the elderly. Few ads addressed cost.  Collectively, these research findings are typical of this body of literature.

Related articles:  How to doctors come to know about new drugs?   Interaction of drug firms and physicians       

Merck and Pfizer fought marketing battles     Impact of drug promotions on doctors' prescription decisions

How should I dispose unused pills    Ethics of marketing new drugs to doctors     Extraordinary Measures movie review

Relationship of pharmaceutical companies and doctors    Impact on prescription behavior due to marketing by pharma companies

Overall impact of drug promotion and advertising on pharma industry   Accelerated drug approval process at the FDA is broken

How to avoid prescription drugs

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