The controversy over the famous lunches paid to doctors by pharmaceutical companies surfaced. In the US, a study has shown that doctors who accept such meals more we prescribe drugs touted them around the table those who do not receive these favors.
By matching payments to physicians by the pharmaceutical industry with the history of prescribing physicians, researchers have shown that only meal of US $ 20 is associated with a higher rate of prescription drug promoted during the meal.
“Additional meals are associated with an even greater increase in the prescription rate,” the authors write in the Journal of the American Medical Association (JAMA).
The effect is far from marginal. Take a doctor gets paid for four days or more meals during which pharmaceutical representatives speak of him Nebivolol, a drug against hypertension. Statistics show that the doctor is 5.4 times more likely to choose the Nebivolol over other drugs in the same class that doctors who did not accept meals targeting the drug.
Previous studies have shown that a doctor receives more money from a pharmaceutical company, the more it tends to prescribe innovative drugs, which are more expensive than generics. But this is the first time we showed a link between the promotion of a specific drug and the prescription of this medicine.
Robert Steinbrook, editor for JAMA and professor of internal medicine at Yale University, believes these findings raise important issues. “We should not delude ourselves: payments from pharmaceutical companies to physicians are marketing expenses. ”
“It is clear that the industry believes that the billions of dollars spent and generate a return on investment. Ultimately, this increases the costs of the health system. ”
Robert Steinbrook, editor for JAMA and professor of internal medicine at Yale University
RELATIONSHIP OF CAUSE EFFECT?
Note that the researchers have not directly demonstrated that the free meals alter prescribing habits of doctors. Their study links between the offered meals and medication prescription rates, but it is impossible to know if there is a cause and effect relationship. It is possible, for example, a doctor who prescribed medication already accept free meals for more on this.
In the US, the combination of innovative drug companies, the Pharmaceutical Research and Manufacturers of America, told Bloomberg that the study published in JAMA is based on selected data “piecemeal” to support “erroneous findings” (narrative false).
innovative medicines Canada, which includes Canadian business Original medicines, also expressed unimpressed.
“The researchers themselves say they could not find cause and effect. A simple association is established. Whether it has negative effects is another question that the study does not answer at all. ”
Elaine Campbell, Innovative Medicines Chair Canada
But to Dr. Robert Steinbrook, who signed an editorial in JAMA to accompany the study, the debate on what falls cause and what is effect is “vain.”
“Ultimately, these links between the pharmaceutical industry and doctors should not exist, slice there. In my opinion there is no valid reason for a doctor to accept such largesse. ”
ETHICS AND PROFESSIONAL CONDUCT IN QUEBEC
In Quebec, the Code of Ethics of the College of Physicians states that a physician “shall adhere to any agreement or accept any benefit that could influence his professional practice.”
The phenomenon lunches paid by pharmaceutical companies is still well present. These meals can be taken within the framework of accredited continuing education activities. In this case, they are supervised by the Quebec Council of continuing professional development of doctors, which has its own code of ethics.
“There are also other training activities that are not accredited and which the College of Physicians has no control, admits Caroline Langis, spokesman for the College of Physicians. That’s when the free choice of doctor or not to accept food offered by a pharmaceutical company. ”
Note that in Quebec, pharmacists are required to offer patients the cheapest generic, if it exists, even if the doctor prescribed the original drug. This could mitigate the effects of a hypothetical doctor who would be influenced by a pharmaceutical company choosing to prescribe an original drug.
The pharmaceutical industry argues that food is the most effective way to inform doctors about new drugs, including their security and their interactions with other substances.
“In many cases, the only time when doctors are available to receive information about new products we put on the market during lunch,” says Elaine Campbell of Innovative Drugs Canada. Since doctors are not paid during this time, Ms. Campbell considers that this is the least that companies pay the meal.
Ms. Campbell admits that meals paid physicians are recognized as marketing expenses. Companies do they expect a return on the money spent? “There are no measurements on returns,” she replies.
COLLEGE OF PHYSICIANS WANTS TO KNOW
The US study that links between meals paid to doctors and prescriptions could be done for a reason: the United States, a law requires pharmaceutical companies to disclose payments to doctors and hospitals.
This law, called the Sunshine Act, has no equivalent in Canada. In the spring, 10 pharmaceutical giants have announced that they voluntarily reveal the amounts they pay to Canadian physicians next year. Unlike the US situation, the individual amounts paid to each physician will however not disclosed.
In an interview with La Presse, the College of Physicians of Quebec was in favor that Canada adopt a law similar to the US Sunshine Act.
“We would have no objection, on the contrary. It might help us to ensure that physicians respect their code of ethics and always make proof of professional independence, “says Caroline Langis, spokesman.
innovative medicines Canada, the association of brand-name drug companies, is much cooler to the idea.
“I think the usefulness of this database is embryonic, said the president Elaine Campbell. […] Our position is that if our members choose to reveal information they should. ”