Chressanthis and his colleagues from AstraZeneca and ZS associates1 describe how physician contact with pharmaceutical sales representatives influenced both new prescribing and responses to black box warnings. They conclude that “limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs.”
These authors underplay the obvious fact that the primary goal of pharmaceutical representatives is to increase sales of their products relative to those of their competitors. Use of negative information about established products of competitors (they mention rosiglitazone from GlaxoSmithKline and simvastatin/ezetimibe from Merck & Co./Schering-Plough Pharmaceuticals) can surely not be regarded as disinterested. The authors’ study can perhaps be seen as simply another demonstration that pharmaceutical detailing works—hardly a surprise.
Less obvious is that this study underlines the massive imbalance between pharmaceutical detailing and sources of unbiased information such as “academic detailing.” Grande2 highlights the imbalance—one pharmaceutical representative for every 5 office-based physicians—against Pennsylvania’s 10 academic detailers for 48,000 doctors.
As far back as 1996, Wolfe3 showed that in the United States more is spent on pharmaceutical advertising in its various forms than the total expenditure of all medical schools. It is not therefore remarkable that, as shown by Chressanthis, use of unbiased pharmaceutical data has atrophied over recent decades when compared with the product detailing provided by pharmaceutical companies.
We suggest that this study provides further evidence of a need to redress the balance. We can do so by promoting better, cost-effective, and unbiased mechanisms for physicians to learn of new drugs and developments and by further limiting pharmaceutical detailing.