Intended for healthcare professionals


So much time for so little: Italy's pharmaceutical industry and doctors' information needs

BMJ 2000; 320 doi: (Published 01 January 2000) Cite this as: BMJ 2000;320:55
  1. Emilio Maestri, general practitioner,
  2. Gilberto Furlani, general practitioner,
  3. Fabio Suzzi, general practitioner,
  4. Annalisa Campomori, pharmacist,
  5. Giulio Formoso, epidemiologist,
  6. Nicola Magrini, head (n.magrini{at}
  1. Guastalla, Reggio Emilia, Italy
  2. Imola, Bologna, Italy
  3. Unit of Drug Evaluation and Evidence-Based Primary Care, Centro per la Valutazione della Efficacia della Assistenza Sanitaria (CeVEAS), 41100 Modena, Italy

    EDITOR—Two local experiences in northern Italy may be relevant to the discussion following the recent editorial by Griffith on doctors' reasons for not seeing drug representatives.1

    In 1992, eight general practitioners from Guastallae evaluated the amount of time spent with pharmaceutical representatives. On average, each doctor had 435 visits per year from 102 different companies and spent a total of 58 hours every year talking to pharmaceutical representatives. To reduce this time, four doctors allowed up to two visits per day, and four allocated a single weekly session, allowing up to eight visits, but this approach did not lead to the desired results (table).

    In 1994, four of these general practitioners contacted 102 drug companies, asking to receive information based on systematic evaluation of available evidence rather than glossy booklets and favourable trials only. Nothing changed except that staff specialists joined the visit. In 1996, drug companies were asked to send their representatives only when invited or when relevant information was available in advance. Most representatives stopped visiting doctors' surgeries, and only three out of 102 agreed to answer specific questions.

    Interactions between drug representatives and eight general practitioners in Guastalla, Italy, in 1992-3

    View this table:

    In 1992, four general practitioners from Imola, after the publication of a drug formulary,2 asked 105 drug companies to submit only clinically relevant information and answer doctors' specific questions. This put a complete stop—which still persists—to visits from drug representatives.

    We analysed some typical “information packages” and found that “drug oriented” information is often flawed, biased, or misleading 3 4: protocols of ongoing studies are used as evidence of clinical benefits; unpublished data on file are quoted as reliable references; pharmacological or molecular effects are overemphasised; and all this is almost regularly accompanied by an invitation to gather your own experiences with this drug and then judge. This is not patient oriented information drawn from a systematic evaluation of available evidence.

    Transforming advertising into reliable information is probably impossible. Pharmaceutical companies are well equipped to produce and disseminate information about their drugs, and they are one of the main sources of information for doctors. Health authorities should arrange a similar system, using dedicated professionals to provide doctors with valid and unbiased information. Interventions of this sort should be included in the current effort by Italy's health service to produce and implement practice guidelines. Local centres could be used to make this information easily available to doctors and to determine and evaluate the best strategies for dissemination and implementation.5


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