Breaking up the cozy relationship between physicians and drug company representatives could lead to improvements in healthcare and significant reductions in drug costs, a new report suggests.
Researchers from Oregon State University, Oregon Health & Science University, and the University of Washington noted drug reps promote the newest, more costly, and often unnecessary prescription drugs to physicians and pour billions of dollars into marketing them to doctors and patients.
More than 90,000 drug representatives provide gifts and advice to doctors, with one drug representative for every eight doctors in the United States, the researchers said. This doesn't necessarily serve the best interests of patients in terms of economy, efficacy, safety, or accuracy of information, experts say.
Removing drug company representatives from physician practices would lead to better care and keep medication costs low, the researchers reported in an article published in the Journal of the American Board of Family Medicine. Their conclusions are based on the experiences of a Madras, Ore., clinic that made such a change.
The researchers acknowledged, however, that avoiding conflicts of interest and becoming "pharma-free" is not easy for physicians to do.
"This is a culture change, one that's already happening but still has a ways to go, especially in smaller private practices," said David Evans, M.D., a physician with the Department of Family Medicine at the University of Washington, and previously a doctor at the Madras clinic featured in the article.
"The relationship between physicians and drug company representatives goes back generations, and it took a methodical, deliberate campaign to change it," Evans said. "We ultimately decided something had to be done when our medical clinic was visited by drug reps 199 times in six months. That number was just staggering."
The reported noted the relationship at one time benefitted doctors by keeping them up to date on new medications, and gave them access to "free" samples to get patients started on the newest drugs, as well as other supplies and gifts.
But information on new medications is now available in many other forums that may have less bias and be more evidence-based than the material traditionally provided by the pharmaceutical industry. In the Madras clinic, the physicians replaced information previously supplied by drug reps with monthly meetings to stay current on new medications, based on peer-reviewed, rather than promotional literature.
"In the past 5-10 years there's been more of a move toward what we call 'academic detailing,' in which universities and other impartial sources of information can provide accurate information without bias," said Daniel Hartung, assistant professor in the OSU College of Pharmacy. "This is being supported by some states and the federal government, and it's a move in the right direction."
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