The findings, published Wednesday in the journal, PLoS Medicine, offer a broad look at the relationship between doctors’ prescribing habits and their exposure to information provided by drug companies. Researchers analyzed 58 separate studies of this phenomenon from Canada, the United States, Europe and Australia, dating from the 1960s.

Left: Joel Lexchin

“Many doctors claim they aren’t influenced by the information provided by pharmaceutical companies. Our research clearly shows that they are – and the influence is negative,” says Lexchin, a professor in the School of Health Policy & Management in 91ŃÇɫ’s and an emergency physician in Toronto.

“Unfortunately, patients are the ones getting a raw deal. If doctors are inundated with advertising from brand- name companies, they are more likely to prescribe that brand name, regardless of whether it’s best for the patient.”

All but one of the studies suggested that exposure to promotional information was associated with lower prescribing quality; the one remaining study detected no association. Findings also show that promotional information led to more frequent prescribing; studies dealing with this correlation either showed a spike in prescribing or detected no association. Researchers also established a link between promotion and higher prescribing costs.

Lexchin says Canadian drug companies spend big money on marketing their products to physicians, to the detriment of other priorities such as research and development.

“In Canada, companies are estimated to be spending anywhere between $2.4 and $4.75 billion annually on promotion, one of the major reasons why spending on brand-name drugs was rising at a rate of just under 10 per cent annually until two years ago,” he says.

A limitation of the research is that most studies were observational in nature, meaning that the majority of physicians who participated were not randomly selected.

The researchers found no evidence that drug companies' promotional efforts improve prescribing behaviour in any way, but, says Lexchin, “that doesn’t entirely exclude the possibility that prescribing might sometimes be improved.” However, he adds, "As a precaution, we recommend that physicians avoid exposure to the information provided by pharmaceutical companies.”

The study, “Information from pharmaceutical companies and the quality, quantity and cost of physicians’ prescribing: a systematic review”, was led by Geoffrey Spurling, a professor at the University of Queensland, Brisbane, Australia. To read it, visit the website.

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin

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Drug prices in Canada can be unregulated for years, a period during which companies may overprice the drugs and market them, says Lexchin, a professor in the School of Health Policy & Management in 91ŃÇɫ’s and an emergency physician at the in Toronto.

Left: Dr. Joel Lexchin.

His commentary, “”, appears in the journal Open Medicine. It is based on new research which examined how many drugs in Canada are marketed before they are patented, whose prices are therefore not controlled by the federal Patented Medicine Prices Review Board. He also looked at the time period between marketing and patenting, and any excess revenue generated before those drug prices were regulated.

In total, 42 drugs were marketed between 2000 and 2008 before being patented, and complete data was available for 33 of those.

“Some of these drugs were potentially being marketed for weeks before they came under the jurisdiction of the review board and had their prices controlled, but some of them may have been marketed for years,” says Lexchin. “Only three of the 33 drugs were found to be overpriced, but the fact that one of the 33 drugs may have been marketed without price controls for more than seven years is troublesome.”

When drugs are finally patented, their prices are reviewed and if a drug is deemed to be overpriced, the review board can order a company to repay any excess revenue to the federal government. The problem is that if companies overprice their drugs, the drugs may not be added to provincial formularies such as the Ontario Drug Benefit Formulary. In Ontario, the government covers most drugs listed on the formulary for people who are eligible, so if a drug is not on the list, the cost will not be covered.

In addition, although excess revenue from the drugs is eventually recovered, it is paid to the federal government, not the provincial governments which fund drugs through their drug benefit schemes, or to private insurers or people who are paying the cost out-of-pocket, says Lexchin.

The best remedy for various problems caused by using patent status to regulate prices is simply to treat all drugs on the market equally and regulate all prices, he concludes.

More about Joel Lexchin

Dr. Joel Lexchin received his doctor of medicine from the University of Toronto in 1977 and for the past 22 years has been an emergency physician at the University Health Network. He is currently a professor in the School of Health Policy & Management at 91ŃÇÉ« and an associate professor in the Department of Family & Community Medicine at the University of Toronto.

From 1992 to 1994 he was a member of the Ontario Drug Quality & Therapeutics Committee and he was the chair of the Drugs & Pharmacotherapy Committee of the Ontario Medical Association from 1997-1999. He has been a consultant for the province of Ontario, various arms of the Canadian federal government, the World Health Organization, the government of New Zealand and the Australian National Prescribing Service.

He is the author or co-author of more than 90 peer-reviewed articles on topics such as physician prescribing behaviour, pharmaceutical patent issues, the drug approval process and prescription drug promotion. He is a co-author of and author of Drug Therapy for Emergency Physicians.

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin.

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