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At the heart of general practice since 1960

Should you see a drug rep calling on spec?

After a busy morning surgery the receptionist rang through while you were trying to drink coffee and sign prescriptions. 'There's a rep just come in. She's brought some doughnuts. Could you see her

for five minutes?'

Dr Peter Moore advises.

Is there a right approach to the pharmaceutical industry?

Some GPs are willing to see drug company representatives at any time, some only see them by appointment and some refuse to ever see them. Opinions vary, with some doctors believing it is unethical to ever see a rep and some accepting whatever hospitality is on offer. It is important that every GP has thought through the issues and worked out a personal policy. Within limits, there is no absolute right and wrong and GPs need to be tolerant of colleagues who have considered the issues and come to a different conclusion.

If the registrar agrees to see the rep there is no excuse to be rude; it is common courtesy to listen. It is also a two-way process: a good rep will listen. If there is a good reason why the product is not being prescribed ­ such as the cost, taste or size of tablet ­ this information could be fed back to the company.

If I am happy to see reps should I see one who has walked in without an appointment?

It is important to know the practice policy. If the practice has made a conscious decision to discourage reps the registrar has to be careful not to undermine the partners.

Even if the registrar and practice are comfortable seeing reps, think about whether it reasonable to see one who has walked in on spec. Most reps have to show their regional manager how many doctors they have seen and so a quick 'hello' is useful for them.

But practices that see reps usually do so by appointment and there is often a long wait. There are so many companies that, even if a doctor agrees to give appointments to reps two or three times a week, there may still be several months' wait. Is it fair on the all the reps who are waiting for their appointment if another one can simply walk in and be seen?

Can I believe the evidence presented?

There is no hidden agenda ­ drug reps are salesmen and women selling a product. They can have an educational role introducing new products of discussing old ones but they are not educationalists. If they do present new and potentially interesting ideas it is worthwhile looking it up in a reputable peer-reviewed journal later on.

There are many ways in which it is possible to provide impressive and biased information. Even if a paper is presented from an eminent source published in a reputable journal it is possible that this paper has been selected as the most favourable to the product. A scientific paper can be misrepresented. If a graph is shown comparing the advertised product with a competitor, the y-axis may not extend to zero. The scale can be extended to give the impression of a larger difference than exists.

Beware of subsets. A research paper can be presented with a large number of patients but by looking at subsets the number dwindles. For example, if a study took 4,000 patients and only looked at hypertensive people over 50 with a BMI over 35 and cholesterol above 7.0mmol/l, the final number will be much less.

What guidelines do the companies follow?

Drug companies have to follow the Codes of Practice of the Association of British Pharmaceutical Industries. These are quite strict and clear. Promotional material comparing products should not be misleading. Any promotional material must contain clear prescribing information including dangers, side-effects and costs. They cannot even use the word 'safe' without further qualification.

They cannot use e-mails, faxes or text messages for advertising unless the doctor asks. They cannot disguise advertising as 'research' or 'clinical assessment'. And reps must not offer inducements for an interview, although the doughnuts are probably allowable!

Details of advertising in mailings and journals are laid down in detail. Any gifts must be inexpensive and related to running the practice. Inexpensive means that it must not have cost the company more than £6 plus VAT. Hospitality can only be given as a part of a scientific meeting and the costs must not be more than the doctors would normally pay themselves. It must not be offered to anyone other than health professionals and appropriate administrative staff.

Is there any evidence

that seeing drug company representatives affects GPs' prescribing?

There is now evidence suggesting the doctors most willing to see drug reps are more likely to prescribe new drugs, are less likely to end a consultation without a prescription and are more likely to prescribe a drug not clinically indicated.

Key points

 · It is important that every GP has thought through his or her relationship with the pharmaceutical industry and has a personal policy

 · GPs need to respect the views of colleagues who may take a different view

 · Any doctor agreeing to see a rep should listen and treat them with common courtesy

 · Drug company representatives are salesmen not educationalists

 · There are clear codes of practice laid down by the ABPI

 · There is some evidence that reps influence doctors

References

1 ABPI Codes of Practice available on www.abpi.org.uk/publications/pdfs/

codeofpractise03.pdf

2 Abbasi K, Smith R. Editorial: no more free lunches. BMJ 2003;326:1155-6

3 Watkins C et al. Characteristics of GPs who frequently see drug industry representatives: national cross-sectional survey.

BMJ 2003;326:1178-9

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