Storm in a tea cup?

With a case against the makers of Vioxx in the courts and the marketing practices of pharma companies square in the public eye in Australia, Insight, a topical TV news program in the region, recently featured a panel of doctors, patients, industry change advocates, pharma representatives and...

By Anonymous (not verified) on Jun 9, 2009

With a case against the makers of Vioxx in the courts and the marketing practices of pharma companies square in the public eye in Australia, Insight, a topical TV news program in the region, recently featured a panel of doctors, patients, industry change advocates, pharma representatives and Medicines Australia officials gathered to discuss the relationship between drug companies and doctors and how it affects patients.

While the discussion deteriorated at times into a bit of a sandlot brawl among the participants, the issues touched upon during the conversation essentially painted a roadmap for the industry of the issues of importance to the press, activist groups, doctors and patients.

Its clearly an advantage for pharma to be aware of the publics perceptions and to identify key issues of importance in their minds. After all, dealing with these issues head-on might help the industry burnish its public image or at least head off criticism by anti-industry groups and others.

The value of education aids or not
GP doctors participating in the discussion said they were visited by as many as 15 pharma representatives per week, but that they were glad to see those promoting a new product or offering information in areas in which the physicians were not well versed. When quizzed about the gifts or detail aids brought by reps, the doctors said much of the educational materials and aids were of great assistance in communicating with their patients about their conditions.

In fact, despite the fact that Vioxx has been pulled from the market, one physician said she keeps a shoulder model in use in her practice as a demo for her patients because its so useful.

One physician even said the branding of such items, as well as pens and other more promotional gifts didnt tend to stick with them. And although the physicians admitted they can be influenced by advertising, they said not unduly so to the point where they would inappropriately prescribe medications.

But Bill Ketelbey of Pfizer Australia says the industry has come to appreciate that although such promotional materials are often of minimal value, theyve become a bit of a lightning rod for detractors for the industry which are beginning to detract and negate the professional interaction that were trying to have with doctors. So, Ketelbey says, through the Medicines Australia code of conduct the industry is voluntarily doing away with much of what it has given to doctors.

Dr. Don Jureidini of Health Skepticism took some of the onus off of the industry, who he says has a responsibility to make a profit (which at least in part involves marketing), and put the ball back in the physicians court to set aside any personal benefit from their relationships with pharma to protect their interests of their patients.

Despite claims to the contrary by physicians, Professor Paul Komesaroff of the Royal AAsian College of Physicians says doctors are influenced by industry advertising. It has an effect on the prescribing habits of clinicians, he says, and contaminates the relationships between doctors and their patients. The industry only spends its marketing dollars on the practice because it works, he says.

Will Delaat of Medicines Australia, the industrys self-regulation body, says the new ban on branded gifts will include anything deemed likely to leak outside the surgery into the general public, such as pens, tissue boxes, coffee cups and note pads. Insights host, Jenny Brockie, used the comment as a chance to bring up the topic of drug samples.

While some of the doctors on the panel said the free samples helped keep patient and government costs down, Jureidini said it encourages patients to use expensive drugs and that most of the samples went to those who could best afford the medication, including the doctors own family, rather than indigent patients most in need.

Patients on the panel said the free samples theyd received had lasted long enough to prevent having to fill a prescription at all or allowed them to try medications that didnt end up working, saving the government the cost of a pointless prescription.

One rep, two rep, three rep, four
The conversation quickly turned back to the value of the medical information imparted by reps and at industry sponsored events. Gordon Renouf said his group, Choice, surveyed GPs about visits from drug reps and found that the average number of visits to doctors was 7 reps per week, while a third were visited by at least ten and some were called on by more than 20 reps. But because so many reps are seeing doctors, he says, theyve become an important source of information.

Renouf argues, however, that consumers will be better served when doctors have more access to objective and clinically valid information from independent sources. But Delaat countered that the makers and discoverers of the medicines pharma are the ones with all the information and only want to educate doctors in the use of those medicines in the context of the disease.

Dr. Joann Goodier, a practicing GP, agreed that physicians need the interaction with pharma. We need to be able to find a way to work together and really openly, she says. There is a balance. They have the information.

Ketelbey agreed to the need and said his company spent $6 million last year on 3,000 educational events reaching more than 100,000 doctors. Its clear that GPs value what we are doing and in fact in very recent market research, the commentary has been that they believe their patient care would have been substantially diminished had it not been for the education that we are providing.

Jureidini argues, however, that the evidence shows that the information given at drug company sponsored educational events is not balanced and favors products being sold by those companies. It is, however, bona fide, genuine education that doctors want, says Delaat. Doctors see value in it and turn up at the meetings, he says. And as far as representatives are concerned, theres about 90% of GPs very happy to see reps get that kind of input into their knowledge about new medicines. I think it is a bit of a storm in a tea cup essentially.

Patients first
Delaat says the bottom line is that despite being fiercely competitive operations focused on making a profit, pharmas still put patient outcomes first. They would go out of business very fast if they werent concerned with patient outcomes, he says.

But pharma still has to convince its detractors and the general public that its sincere about putting patients first. As Komesaroff points out, its important to have this conversation within the community and suggests there needs to be a process of cultural change. Just as its found self-regulation through Medicines Australia to be preferable government imposed sanctions, the industry wants to find itself driving the community conversation and that begins with identifying all of the issues. The Insight program, while a bit of a playground brawl, seems to have gone a long way at least in doing just that.

To view the full program, visit http://news.sbs.com.au.