The Pharmacy Read List: November 17th Edition

Happy Monday everyone and welcome back to the Pharmacy Read List! The Read List is a biweekly update on pharmaceutical literature. Every two weeks we handpick one of the most relevant and interesting pharmacy-related publications and summarize it for your convenience. At the end of every month, a quiz on that month’s content will be released. Simply take the quiz, and you’ll be automatically entered into a draw for a gift card prize!

This edition is the second of November and brings with it a new quiz. The quiz covers both the last article and this article. Simply complete the quiz and you’ll be entered into a draw for a $10 Starbucks gift card!

>>November Read List Quiz<<

For this week, comes a unique article on the industry marketing of medications.
Instructions to access: Copy and paste the article title into UBC Summons to read the full article.

Pharmaceutical sales representatives and patient safety: a comparative prospective study of information quality in Canada, France and the United States.

“I take it with a grain of salt” – Is the information from the pharmaceutical sales representatives balanced?

This prospective cohort study aimed to examine the completeness of information provided to family doctors by pharmaceutical sales representatives during sales visit in cities of Vancouver, Montreal, Sacramento, California, and Toulouse, France. The main objective of the study was to measure how often information on potential harmful effects of promoted drugs was provided. Canada, the US, and France differ in how they regulate drug promotion. The United States (US) and France directly regulate drug promotion; Canada relies on industry self-regulation. France has the strictest information standards. The researchers asked whether this leads to differences in the quality of information provided. A random sample of primary care physicians was drawn in each city. Physicians who see sales representatives as part of their normal practice were invited to participate. Physicians were asked to treat sales visits as they usually would and to report the information provided, whether spontaneous or in response to questions, on a questionnaire they filled immediately after the sales visit. If a sales representative mentioned at least one approved indication, common adverse event, serious adverse event and contra-indication (and no unqualified safety claims or unapproved uses), they were considered to have provided “minimally adequate safety information”. 255 physicians participated and reported on 1,692 drug-specific promotions. Researchers found that fewer than 2% of the 1692 drug promotions included “minimally adequate safety information.” This did not differ by country. Serious adverse events were mentioned only 5-6% of the time, despite the fact that over half of the drugs promoted carried US FDA ‘black box’ warnings or Health Canada boxed warnings of serious risks. In addition, in 40% of promotions in Vancouver and Montreal, no oral or written information on harm or contraindications was provided. If only oral information is considered, no harm was mentioned 59% of the time in the four sites. In Toulouse, sales representatives were more likely to mention harm (in 61% of promotions) compared to the North American sites (35%). This study involved over 300 brand-name drugs in total, and 25% of promotions were for drugs the physician had not previously prescribed; no harm was mentioned in over half of promotions for these drugs. Surprisingly, despite the lack of information on harm, physicians judged the information quality positively and stated their readiness to prescribe. Although the study only measured intent and not prescribing decisions, these findings raise serious concerns about the basis for prescribing decisions questioning if the current regulations on sales representatives serve to adequately protect patient health.

– Harpreet Bahniwal
B.Sc. (Pharm) Candidate 2016


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