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Comment: Drug sales reps could be bad for your health

It sometimes takes a long time to discover environmental hazards, and even longer to do something about them once they are discovered.

It sometimes takes a long time to discover environmental hazards, and even longer to do something about them once they are discovered.

Second-hand smoke, leaded gasoline and asbestos were all deemed bad for our health many years ago, yet the lag between discovering those hazards and doing something to eliminate them covered many years and cost many lives.

This week, a study concerning the world of prescription-drug information identified a new and potentially deadly hazard: the pharmaceutical sales rep visit. This study, published in the Journal of General Internal Medicine and carried out by researchers in Canada, the U.S. and France, asked the question: When a drug sales rep has a private one-to-one conversation with a doctor, what kind of drug information does the physician actually receive?

If you’ve ever seen the well-dressed men and women with iPads and nice shoes in your doctor’s waiting room, you’ll know what a drug sales rep looks like. Working on behalf of pharmaceutical companies, they visit our doctors on an individual basis, dropping off free samples of medications, talking up the company’s products and otherwise schmoozing our physicians, often promoting the newest and most expensive medicines.

This form of marketing is common in most countries, yet it has largely escaped close research scrutiny. It’s also very big business. Drug sales reps and the samples they drop off consume more than two-thirds of the estimated $2.5 billion that the drug industry spends on drug marketing and promotions in Canada every year.

You might ask — what’s wrong with that? Isn’t it a good way for our doctors to discover new products and get acquainted with the latest medicines?

Unfortunately, the opposite might be true. The study released last week found that the one important piece of information that physicians need — information on the potential harms or adverse effects of newly promoted drugs — is usually missing from the sales encounter. The study found that in nearly 60 per cent of promotional visits, sales representatives failed to provide any information about common or serious side effects of the promoted drug, and also failed to inform doctors about the types of patients who should not use the medicine.

In Vancouver and Montreal, two-thirds of the promotional visits involved absolutely no mention of a drug’s potential harmful effects.

Probably most worrisome is that across all three countries, serious drug harms were mentioned in only six per cent of the promotions, even though more than half of the medications being promoted in these office visits were drugs that came with U.S. Food and Drug Administration “black box” or Health Canada boxed warnings — ones that are reserved only for the most serious and potentially fatal drugs.

Barbara Mintzes, an expert in drug advertising at the University of B.C. and a co-author of the study, said she’s concerned that such a situation leaves doctors and patients in the dark and can seriously jeopardize patient safety. Despite laws in all three countries requiring sales representatives to provide information on the potential harms as well as the benefits of drugs, she said, “no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion.”

The study reinforces the conclusions of a recently published systematic review of a wide body of international research showing that physicians who are exposed to more drug-company-sponsored information tend to prescribe costlier drugs and more drugs in total, and have lower-quality prescribing practices.

This earlier study examined all the research in the area and failed to find net improvements in prescribing practices resulting from drug-company visits. Instead, they recommend that physicians “follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.”

This might be the take-home message from the new three-country study as well. All medicines can harm as well as help; doctors need to know about both effects. Incomplete information on a drug’s safety is likely to lead to harm, akin to an environmental toxin.

So, now the real question is: How long will it take before public authorities determine people are being harmed? And what regulations will they put in place to make sure our physicians receive balanced information about the benefits and harms of our pharmaceutical drugs?

Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, was a collaborator on this research study.