Characteristics of general practitioners who frequently see drug industry representatives: national cross sectional study
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7400.1178 (Published 29 May 2003) Cite this as: BMJ 2003;326:1178
All rapid responses
I believe that the paper, “Characteristics of general practitioners
who frequently see drug industry representatives: a national study” which
appeared in the BMJ of the 31st May 2003 is methodologically flawed. What
is more I believe that other papers are similarly flawed.
Approximately 50% of currently practising single handed GPs were
educated overseas. The percentage of overseas doctors operating in
practices of larger size is a smaller percentage. For these doctors, not
only has undergraduate training been different, the culture of origin been
different but it is now accepted that these doctors have been subjected to
institutional racism during their NHS careers. Therefore when we
currently compare practices by size, we are not comparing like with like.
Such comparisons of practice size and performance remain grossly
flawed if not meaningless.
A seminal paper by Campbell and Roland is similarly flawed (1) .
This paper purported to demonstrate a significantly inferior delivery of
clinical service to patients with diabetes by single handed GPs. These
findings were presented amongst others to the negotiators of the new GP
contract.
Such papers and others prolong and perpetuate unhelpful myths.
1. Identifying predictors of high quality care in English general
practice: observational study S M Campbell, M Hann, J Hacker, C Burns, D
Oliver, A Thapar, N Mead, D Gelb Safran, and M O Roland BMJ 2001; 323:
784.
Competing interests:
None declared
Competing interests: No competing interests
Assuming this study is valid. We have to confess that the decision in
prescription is our hand and this decision influenced by endless factors
and possibly drug representative is one. On the other hand ,I think, drug
representatives should be thanked for keeping doctors (GPs) up-to-date
with evidence based prescription whether by frequent visits to surgery or
arranging special educational meeting.
Competing interests:
None declared
Competing interests: No competing interests
Decisions on prescibing are far more influenced by the Government's
Drug budget, than by seeing a Medical Rep once every now and then. The
incentives from the PCT's NOT to prescribe is much more of an influence on
how NOT to prescribe the best available medicine, but the generic at all
cost. And guidelines advising that GP's should NOT prescribe statins when
the evidence is clear that it would benefit in primary prevention in
patients with high cholesterol, because it is not 'affordable'as the
British HEart Foundation has stated is by far a greater influence than
being prompted by a rep to prescribe Pantoprazole rather than Rabeprazole
for example. It would be interesting to do another questionaire to assess
whether the GP prescribing was associated with an 'immoral' prescribing of
newer drugs, or whether the GP still believed that the patients were
getting the best possible benefit. So too I find it very condescending on
the whole that anyone would accept that a medical professional would
prescribe 'unethically' (rather than the "gray-area"); just for a meal or
two!
Competing interests:
None declared
Competing interests: No competing interests
Weapons of mass description
such as these are being used against single-handers. I don't like
it.
Competing interests:
I'm a single-handed GP.
(And on the editorial advice board for a pharmacological industry paper.)
Competing interests: No competing interests