Ellen Reynolds1, Line Guénette2, Joel Lexchin3, Alan Cassels4, Michael S Wilkes5, Geneviève Durrieu6, Marie-Dominique Beaulieu7, Barbara Mintzes8. 1. School of Public Administration, University of Victoria, 3800 Finnerty Rd, Victoria, British Columbia, V8P 5C2, Canada; School of Population and Public Health, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada. 2. CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit AND Faculty of Pharmacy, Laval University, 2325 Rue de l'Université, Ville de Québec, Quebec, G1V 0A6, Canada. Electronic address: line.guenette@pha.ulaval.ca. 3. School of Health Policy and Management, York University, 4700 Keele St., Toronto, Ontario, M3J 1P3, Canada. Electronic address: joel.lexchin@utoronto.ca. 4. Department of Human and Social Development, University of Victoria, 3800 Finnerty Rd, Victoria, British Columbia, V8P 5C2, Canada. Electronic address: cassels@uvic.ca. 5. Department of Internal Medicine, University of California at Davis, 1 Shields Ave, Davis, CA, 95616, USA. Electronic address: mswilkes@ucdavis.edu. 6. Department of Medical and Clinical Pharmacology, Faculty of Medicine, University of Toulouse, 118 Route de Narbonne, 31062 Toulouse, France,. Electronic address: genevieve.durrieu@univ-tlse3.fr. 7. Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada. Electronic address: Marie-Dominique.Beaulieu@umontreal.ca. 8. School of Population and Public Health, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada; Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown NSW 2006, Australia. Electronic address: barbara.mintzes@sydney.edu.au.
Abstract
OBJECTIVES: To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. METHODS: We recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach. RESULTS: Fifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions. CONCLUSIONS: Physicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs' safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.
OBJECTIVES: To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing. METHODS: We recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach. RESULTS: Fifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions. CONCLUSIONS: Physicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs' safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.