Med­i­cal duchess­ing not all it’s wrapped up to be

The Weekend Australian - Travel - - Health - SI­MON COWAP

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

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