Misleading drug promotion harms health and wastes money
Les publicités trompeuses sur les médicaments nuisent à la santé et font gaspiller de l'argent
Six bonnes raisons d'être concerné par la promotion et la publicité des médicaments
- Les laboratoires pharmaceutiques dépensent en moyenne environ 35% de leur chiffre d'affaire pour la promotion et la publicité
- Les laboratoires pharmaceutiques ne dépenseraient pas autant d'argent pour la promotion et la publicité se cela n'influencait pas les prescriptions
- La promotion et la publicité influencent beaucoup plus les prescriptions que ne le réalisent les professionels de santé
- Beaucoup des publicités et des documentations fournies par les laboratoires pharmaceutiques sont trompeuses
- La promotion et la publicité qui exagèrent les bénéfices et minimisent les risques, menacent les traitements idéaux
- Faire confiance aux informations publicitaires peut mettre des vies en danger et expose le prescripteur à des risques de litige
Six good reasons to be concerned about drug promotion:
What impact does pharmaceutical promotion have on attitudes and knowledge?
- Drug companies spend on average around 35% of sales on promotion.
- Companies would not spend such massive amounts on promotion if it were not effective at influencing prescribing.
- Promotion influences prescribing much more than most health professionals realise.
- Many advertisements and statements from pharmaceutical representatives are misleading.
- Promotion which exaggerates benefits and glosses over risks, threatens optimal treatment.
- Reliance on promotional information may endanger lives and expose prescribers to the risk of litigation
Many descriptive studies clearly show that much promotional material contains inaccuracies, or at least presents very selective accounts of the evidence about the drug presented. The question this review addresses is whether and how far promotion (including these inaccuracies and biases) affects the attitudes and knowledge of those who are exposed to it.
Very little research has looked specifically at the effect of promotion on attitudes, much more has examined the effect of promotion on knowledge. The studies here are part of a field of research into the determinants of prescribing – how doctors learn about drugs, and how they come to prescribe new products.
Most of the studies discussed in this review are really about how much doctors report using promotion as a source of information (either for all drugs, or particularly for new drugs) rather than about effects of promotion on attitudes or knowledge. They are included because they provide information relevant to the question of whether promotion affects prescribers’ knowledge.
What impact does pharmaceutical promotion have on behaviour?
- Doctors’ own reports suggest that promotion is often used as a source of drug information, less so by doctors who qualified more recently or who practise in an academic rather than a private setting.
- Self reports indicate that promotion is often used as a source of information about new drugs, especially for indications for which the doctor has less expertise.
- Promotion influences attitudes despite some evidence that the details are not always remembered.
- : Doctors’ attitudes are influenced by promotion much more than they think.
This is both the most difficult area to research and the most important. Doctors may not be aware of how much promotion they are exposed to. Thus, as much as possible, research on the effect of promotion on behaviour should avoid relying on self-report data to show causal relationships. Self-report data are appropriate for finding out what people think is happening, or how they want to present themselves to others, but in this area, that may be far from the reality.
- Doctors rarely acknowledge that promotion has influenced them to make specific prescribing changes. Specialists tend to report that promotion has less effect on them.
- Doctors who report relying more on promotion prescribe less appropriately, prescribe more often, or adopt new drugs more quickly.
- Exposure to promotion influences prescribing more than some doctors realise.
- Samples appear to influence prescribing but more research is required on this issue.
- Increased promotion is associated with increased sales.
- Funding for doctors from drug companies increases requests for drugs to be added to hospital formularies.
- Direct-to-consumer advertising of prescription medicines (DTCA) is associated with increased requests from patients for drugs, and some evidence suggests that when doctors respond positively to these requests they are ambivalent about the product they are prescribing.
- Sponsorship may affect the content of continuing medical education (CME). More research is needed to examine this
- The percentage of research studies funded by drug companies has increased over the past 50 years. Funding of research by drug companies is associated with influence over choice of topic, secrecy, delayed publication for commercial reasons and conflict of interest problems for authors of guidelines.
- Drug company funded research is more likely to show results favourable to the product being studied than research funded from other sources. There is an association between the opinions of investigators about products and their source of funding but causality has not been established.
- Drug company funding of research influences the topics studied
- Funding from drug companies is often not disclosed