Medical duchessing not all it’s wrapped up to be
WITH whom is your doctor having dinner? The relationship between doctors and drug companies is in the news again, following a decision by the Australian Competition Tribunal that details of hospitality provided to doctors must be published on the Medicines Australia website.
This ‘‘ hospitality’’ is mostly in the form of dinners accompanying an educational presentation, or sponsored attendance at conferences. Information provided will include a description of the function, the nature of the hospitality and its cost. You won’t, however, be able to find out whether your own GP or specialist was in attendance.
Patients and health officials are understandably concerned that the pharmaceutical industry wants something in return for all this food and drink. The hospitality proffered is reported as being fairly decadent, sometimes including, it is rumoured, dancing girls on showboats. In short, it is suggested doctors are being duchessed.
Bloated with foie gras, drunk on Grange Hermitage and festooned with garter belts we lurch ashore, call a cab to the surgery and start prescribing the sponsor’s product.
So what’s it really like at these drug company dos? How do GPs manage their relationship with big pharma? Or do they manage us?
We do receive an enormous amount of attention from drug companies. By and large unable to advertise their product direct to consumers, the bulk of their vast marketing effort is directed at us. Drug companysponsored dinners are just a part of this effort. Usually held at a mildly posh local restaurant, attendance commonly consists of six to eight GPs, a specialist and a couple of reps. Because there is a presentation, usually with an audiovisual component, they are in the back/ side/upstairs room.
In my experience
mostly average, sometimes bad and never good enough to sell your soul for.
The evening typically begins with a purely promotional presentation from the drug rep, followed by a talk from the specialist. These are usually not directly related to the drug being marketed, but address topics in the same clinical area. Like the food, their quality is variable, but can be good. Even when the educational content is worthwhile, it constitutes perhaps 45 minutes out of a two-hour meeting. Getting together with fellow GPs and local specialists can be good, but mostly the time is better spent staying at home, eating your own food and reading a couple of articles.
As well as dinners, prevalent marketing tools include drug rep visits, vast amounts of promotional material and sponsored conferences. Unless you take a firm line with reps, you can end up seeing more of them than patients. Young, well-groomed and perennially cheerful, they turn up with tacky gifts and glossy brochures.
This detailing material, while factually correct, is usually manipulated and massaged as much as possible to appear favourable to the product. Simplistically presented, it employs short key messages and lots of graphics.
A number of typical tricks are used. With graphs, for instance, the values on the vertical axes will be chosen to accentuate the apparent effect. If a drug produces, say, a mean drop in blood pressure from 142 to 139mm mercury, the vertical axis will have a range of only 145-135, making this appear visually as a drop of 30 per cent. Other common ploys include emphasising reductions in relative risk where the absolute effect may be negligible, and evaluating the advertised drug against older, less effective treatments rather than current best practice.
Drug reps can have their uses, but the effort involved in decoding the spin is usually not worth it, and as a rule I don’t see them. It’s a lot easier to get drug information from unbiased sources such as the National Prescribing Service.
Medical advertising is characterised by its ubiquity and its awfulness. Highly simplistic, pictorial and emotional, it is designed to give doctors a sense of positive feeling and familiarity with a drug, without enhancing their knowledge one iota. Typically there is a large picture of a grateful patient and some pithy slogan. In very small print somewhere there is an injunction to please review approved product information before prescribing.
This TGA-approved information is the seriously useful stuff. Unlike the ads, it has all the adverse reactions, contra-indications warnings and precautions. It is what the drug companies will rely on when sued — see, we warned you about that risk.
Drug companies and doctors will always have a difficult relationship, and yet we cannot divorce. Like it or not, they manufacture the products we use and are responsible for huge amounts of research and education.
While our agendas differ and the possibility of corruption is always present, interests can also align and some good can come out of the relationship. Most doctors I know have a very healthy scepticism, which is not to say we are never influenced. To borrow from the RSL, the price of virtue is eternal vigilance. That and a strong regulatory framework. Simon Cowap is a GP in Newtown, Sydney