Tight regulation of French drug reps mean French doctors get more balanced information than doctors in the USBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6964 (Published 03 December 2010) Cite this as: BMJ 2010;341:c6964
All rapid responses
Most of the pharmaceutical and related products are introduced to
members of medical community by representatives of the pharmaceutical and
allied sector companies. These representatives are trained by their
respective companies to boost their product sales and help them earn
profits. As is the case with any industry, there's no survival without the
profit. The companies usually set sales targets for these representatives.
In order to promote their products over the ones from competitor firms,
many a times the correct scientific and medical information on the
therapeutic and adverse effects may not be provided by the medical reps.
Sometimes, the crucial information may be concealed or presented in the
distorted manner. Many of the medical community members fall prey to the
not-so-genuine information (and lucrative freebies) being provided by
It is really appreciable that France has set guidelines for medical
detailing and related activities to be undertaken by pharmaceutical
company sales representatives. Obviously, the doctors in France may
receive more balanced information than their US and Canadian counterparts
as has been reported by Silversides . The same article mentions that
French pharmaceutical sales representatives provide information on adverse
drug reaction in 60% of their encounters with doctors (read family
physicians or GPs). The chances of offering free samples and other
freebies are also less.
Recently, France has witnessed the benfluorex scandal . It will be
really interesting to know whether the sales representatives had a role in
the occurrence of the tragedy and how medical community members were
benefited from the company marketing the benfluorex medication.
At the same time, US and Canadian health and drug control authorities
should keep close tabs on drug companies sales representatives as well as
doctors who accept freebies from the drug companies in any form. Such
steps will go in a long way to contribute positively towards the health
care of the citizens.
1. Silversides A. Tight regulation of French drug reps mean French doctors
get more balanced information than doctors in the US. BMJ 2010; 341:c6964.
2. Benkimoun P. French doctors demand to know why drug stayed on the
market for so long. BMJ 2010; 341:c6882.
Competing interests: Pharmacy teaching at UG and PG level.
Ann Silversides comments on preliminary results of a 3-country study
by Barbara Mintzes and colleagues, focusing on interactions between
general practitioners and pharmaceutical sales representatives (BMJ 2010;
341:c6964). She mentions the French code of practice for sales
representatives dated 2004 (Charte de la Visite Medicale) and claims
that promotional information is better regulated in France than in Canada
or the USA. But in 2009 a report by French National Authority for Health
(Haute Autorite de Sante, HAS, in charge of monitoring the Charter)
acknowledged that visits by sales representatives are not being
effectively regulated. Essentially, the HAS review states that the Charter
is ineffective and supervision of sales visits impossible. These facts
were reported in the independent French continuing education journal ÃÃ¢Prescrire. 
The situation in France is not really more satisfactory than in
Canada or the USA in any substantive sense. Prescrire ran a study
monitoring the information provided by sales representatives in France for
15 years, from 1991 to 2005.  Sales representatives cannot be depended
upon to provide fair and balanced comparative information on the drugs
they promote, and sales representatives will never provide that kind of
information. Whether they are providing fewer or more gifts to doctors,
sales representatives are duty bound and have vested interest (higher
bonus) to provide non comparative and commercially biased information.
And putting a positive spin on visits by French sales representatives
is particularly untimely when a scandal about the product Mediator
(benfluorex) is brewing up in France.  Although sales representatives are
not the primary culprits in this health scandal, they were implicated in
the promotion of an anorectic, under the guise of an antidiabetic, which
was associated with heart valve defects.
Regulated or unregulated, promotional information provided by sales
representatives cannot be salvaged. The most effective strategy is for
health professionals to systematically refuse to see sales representatives
and to rely on information sources that are independent of pharmaceutical
Christophe Kopp MD
1- Prescrire Editorial Staff. "The French medical sales charter:
ineffective" Prescrire Int 2010; 19 (109): 235.
2- Prescrire Editorial Staff. 15 years of monitoring and one simple
conclusion: don't expect sales representatives to help improve
healthcare quality. Prescrire Int 2006; 15 (84): 154-159
3- Prescrire Editorial Staff. Mediator: a book that spells
trouble for one drug company.
4- Prescrire Editorial Staff. Pharmaceutical sales reps: no
thanks! Prescrire Int 2003; 12 (66): 152-153
Competing interests: Prescrire had advisory role in study by Mintzes and colleagues
The link to the Drug Industry Document Archive mentioned in the
article is incorrect. The correct URL is http://dida.library.ucsf.edu.
Industry Documents Digital Libraries Manager
University of California, San Francisco
530 Parnassus Avenue, Room 115
San Francisco, CA 94143-0840
Competing interests: No competing interests