Alarms sounded around the globe in 2004 when Vioxx was withdrawn from the market due to its association with cardiovascular toxicity. Following the provision of over 80 million prescriptions worldwide, this withdrawal carried enormous consequences. The story rightfully attracted widespread attention regarding public health implications of drug promotion. The VIGOR study,1 published in 2000, had found Vioxx to increase the risk of myocardial infarction as compared to naproxen, yet Vioxx was promoted as a safer alternative. Worse yet, evidence later revealed in the Vioxx litigations suggested that the authors of the study knowingly understated the rates of myocardial infarction in the Vioxx group that led to misleading conclusions.2 The New England Journal of Medicine later called the authors to submit a correction. Studies also suggested that Vioxx manufacturer, Merck and Co., manipulated data and used academic researchers to enhance the credibility of articles written largely by Merck.3 The editor and deputy editor of the Journal of the American Medical Association responded by saying “the profession of medicine in every aspect — clinical, education and research — has been inundated with profound influence from the pharmaceutical and medical device industries.”4 An investigation showed that Merck and Co. sales representatives systematically avoided presenting evidence of Vioxx's cardiac toxicity to health professionals,5 and the US death toll was estimated at between 35,000 and 45,000.6
The attention being paid to the relationships between the pharmaceutical industry and health care providers is steadily increasing, along with a growing awareness of the link between industry promotion and drug use decisions.7 The purpose of this paper is to identify techniques used by the pharmaceutical industry to promote their products, while highlighting the impact on our patients and profession. By familiarizing themselves with such techniques, pharmacists, pharmacy students and pharmacy schools will be ready to employ strategies needed to appropriately respond to industry advertising and ensure we are meeting high ethical professional standards.
.../...While meeting with a sales representative, it is advantageous to be mindful of a study by Ziegler et al.23 The study indicated that 11% of statements made by sales reps were inaccurate. Equally worrisome is that all inaccurate statements were favourable towards the promoted drug, and none of the statements about competitors were favourable. In September 2009, Pfizer was fined 2.3 billion dollars for illegal promotion of several of their drugs.24 Marketing fines have also been dished out to GlaxoSmithKline, Takeda Pharmaceuticals, Merck, Eli Lilly and Abbott.25 Industry's influence is growing so deep that it may be difficult to recognize. Prominent medical researchers involved in determining treatment guidelines have been paid up to $50,000 in 3 months from drug companies.26,27 Industry documents indicate that clinical trials for Vioxx were authored by employees of the manufacturer, but often attributed first authorship to academically affiliated researchers who did not always disclose payment from the manufacturer.28
Artículo completoVer tambien
The Accuracy of Drug Information From Pharmaceutical Sales Representatives
JAMA. 1995;273(16):1296-1298
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