The Pharmaceutical Journal
Vol 273 No 7325 p702
13 November 2004

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Under the influence?

Apassing comment at a recent conference on adverse drug reactions in psychiatric care has raised an interesting question. Are pharmacists, and other new prescribers, susceptible to the blandishments of pharmaceutical representatives and others in the marketing departments of pharmaceutical companies? (See p707.)

Anyone who makes a prescribing decision (whether it is a primary decision or a secondary decision) is of interest to employees of drug companies. If there is a chance that a prescriber might be persuaded to prescribe a particular product, you can bet your bottom dollar that the marketing boys and girls will be round in a flash, armed with their detail aids and ready to charm. And new prescribers, who may not have yet learnt to differentiate the hard sell from genuine advice, may find them hard to resist.

There is a flaw in this scenario, however. The industry’s techniques may be able to change the prescribing patterns of willing GPs — the group on which the techniques have been tried and tested — but pharmacists, in particular, we imagine, will have a rather different approach.

For a start, long before they start prescribing, they know much more about drugs, the way they work, generic substitution etc, than all other health care professionals — including GPs. Cautious at the best of times, pharmacists are highly unlikely to throw that away and within the context of the clinical management plan prescribe expensive new products and “me-toos” on the word of a company representative without a clear understanding of the evidence.

If anything, industry representatives may find pharmacist supplementary prescribers much harder to influence than GPs and less likely to take up inappropriate offers of lunches, for example. That does not mean that supplementary prescribers will not welcome support and training. Learning to say “no” without appearing rude is important as is learning to keep the wrong sort of information at arm’s length.
Relationships need to be developed that ensure patients are the clear beneficiaries and there is a great deal to be gained from working closely with the pharmaceutical industry. Let us hope that the relationship is not soured by overzealous marketing.

Is self-care better care?

Self-care is almost a government mantra — not quite in the league of “choice” but not far off. Helping patients to be self-sufficient is likely to keep them away from their doctors for longer. But does it mean they are fitter? Erewash Primary Care Trust in Derbyshire will investigate the outcomes of three self-care projects in its area to find out whether participants benefit and have better health or whether they miss out from early medical intervention (p715). The results will be awaited with interest.

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