Our findings suggest that the interaction between physicians and pharmaceutical companies should be better managed to reduce any negative effects and promote appropriate drug prescribing. While many policy options have been proposed to manage the interactions between physicians and pharmaceutical companies, the level of evidence supporting them varies, as described below.
There is an increasing trend of mandating pharmaceutical companies to disclose payments to physicians. For instance, the Physician Payments Sunshine Act enacted in the USA in 2010 requires pharmaceutical and medical device manufacturers to publicly disclose payments (or transfers of values) exceeding US$10 per instance or US$100 per year made to physicians and teaching hospitals. Similarly, Medicines Australia recently revised its code of conduct, requiring pharmaceutical companies to report on payments to individual health professionals for their services, sponsorships to attend educational events, as well as educational grants. However, so far there is no evidence supporting the effectiveness of mandatory disclosure.
As an example of regulatory approach, France introduced in 2004 the French Sales Visit Charter which requires sales representatives to provide physicians with “approved product information”. A report by French National Authority for Health pointed to the ineffectiveness of the Charter and the difficulty in supervising the content of verbal information conveyed during representative visits.
A potentially effective option would be to restrict physician-industry interactions, particularly given the evidence that restriction policies may have a positive effect on improving prescribing behavior. This could be achieved, at the institutional level by restricting free samples, promotional material, and meetings with pharmaceutical company representatives. For example, Stanford University banned pharmaceutical sales representatives from its hospitals. Similarly, Memorial Sloan Kettering Cancer Center and Brody School of Medicine at East Carolina University banned all industry involvement (including funding) in CME, reportedly with success. At a higher level, policy makers may consider legislation specifying the types of interactions that are permissible, and those that are not. For example, Minnesota enacted a law that bans pharmaceutical industries from providing gifts to physicians with a total annual combined retail value above US$50.
While some may claim that restricting interactions between physicians and pharmaceutical companies could create an ‘information gap’, several studies conducted in different contexts found that sales representatives often did not state the risks and harmful effects of drugs to physicians. Academic detailing has emerged as an effective alternative to industry-dependent drug information. For instance, Canada and some USA states have established nationally-funded academic detailing programs that rely on similar sales tactics utilized by the pharmaceutical industry to influence physician prescribing according to evidence-based guidelines.
Considerations should also be given to educating health care providers about the influence of interactions with the pharmaceutical industry, as well as inclusion of courses on industry marketing techniques and conflict of interest in medical curricula. Existing evidence suggests positive effects of educational programs about industry marketing strategies on medical trainees’ attitudes and behaviors. (Más)