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Recent books by critics of the pharmaceutical industry (such as David Healy's Pharmageddon and Ben Goldacre's Bad Pharma) have highlighted problems in the way the industry promotes its products.

In a 2010 article in Bioethical Enquiry, Spielmans and Parry argue the following (this is from their abstract):

While much excitement has been generated surrounding evidence-based medicine, internal docu- ments from the pharmaceutical industry suggest that the publicly available evidence base may not accurately represent the underlying data regarding its products. The industry and its associated medical communication firms state that publications in the medical literature primarily serve marketing interests. Suppression and spinning of negative data and ghostwriting have emerged as tools to help manage medical journal publications to best suit product sales, while disease mongering and market segmentation of physicians are also used to efficiently maximize profits. We propose that while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality.

Is their summary of the current situation correct? Is prescribing dominated by marketing not evidence?

  • @GlenTheUdderboat Medicine usually refers to the whole of medical science. In this context most of the discussion is about the prescribing of pharmaceuticals by doctors. The whole argument of the article is that medical decisions about what to prescribe have become dominated by marketing not evidence. And the authors use of "we propose that" is just incense-journal shorthand for this is our argument, not a modifier suggesting it is vague (as the rest of the paper shows). – matt_black Jan 2 '14 at 19:01
  • @GlenTheUdderboat But that is exactly what it is talking about in context. The whole article is about pharma industry practices that influence prescribing. It isn't making a more general claim. – matt_black Jan 2 '14 at 19:11
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See Spurling, Geoffrey K., Peter R. Mansfield, Brett D. Montgomery, Joel Lexchin, Jenny Doust, Noordin Othman, and Agnes I. Vitry. "Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review." PLoS medicine 7, no. 10 (2010): e1000352.

Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.

Regardless, their opinion is:

we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies unless evidence of net benefit emerges.

Dr. Steven Novella summarizes this study at his blog, Science Based Medicine.

five studies showed decreased prescribing quality, while five studies showed no association or ambiguous results. To me these are weak outcomes, without a clear answer.

and,

After reading this review I am still left with the sense that the data on this important question is currently insufficient – it is mostly observational, and on the two most important questions (cost and quality) the evidence (while trending to the negative) is unclear. What is obvious is that better data would be helpful.

He also agrees that following the precautionary principle is prudent:

Meanwhile I think it is prudent to limit access of drug reps to physicians and their offices

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