Australian campaign aims to stop visits from drug representatives

Australian doctors and medical trainees are being urged to shun drug company representatives in a new grassroots pledge campaign criticised by the drug industry as potentially dangerous for patients and cautiously received by the nation’s leading doctors’ group.

The No Advertising Please initiative (http://noadvertisingplease.com.au) will formally launch on Saturday 11 October at the annual conference of the Royal Australian College of General Practitioners in Adelaide. More than 100 signatories have already taken its pledge not to see drug company reps for the next 12 months, including several high profile medical academics.

The campaign’s founder, Justin Coleman, is hoping for a “culture shift” away from visits by drug representatives—the usual way for doctors to keep up to date with pharmaceutical developments in Australia. It follows similar campaigns in the United States (http://nofreelunch.org/index.htm), Italy (http://www.nograzie.eu), Germany (www.mezis.de/en.html), and the United Kingdom (www.healthyskepticismuk.com).

Coleman said, “It’s very clear and not at all surprising that doctors who see reps prescribe more of the medications which the rep is promoting.” If that weren’t the case, the industry wouldn’t hire representatives, he said.

Describing No Advertising Please as “an awareness raising initiative,” he said, “We’re not campaigning for different legislation or regulation, and it’s not asking pharmaceutical companies or governments to take action—it’s really from the ground up.”

The University of Queensland’s Geoff Spurling, the lead author of a 2010 systematic review that examined the effect of drug company promotion on prescribing,1 is among those who have signed on. “A lot of money is spent by drug companies on their sales force, and both doctors and patients are right to have concerns about the quality of prescribing that results from these interactions and also the credibility of the medical profession,” he said.

Spurling’s review of 58 studies found no evidence of educational benefit to doctors from drug company promotion and identified an association with more frequent, more costly, and lower quality prescribing. Other research has shown that representatives are less likely to discuss a drug’s risks and adverse effects than its benefits,2 and one study has highlighted concerns about financial conflicts of interest.3

No Advertising Please has been endorsed by the Consumer Health Forum lobby group and General Practice Registrars Australia, which represents trainee doctors. The forum’s chief executive officer, Adam Stankevicius, said that the initiative brought “a new and refreshing level of transparency into medical practice” that “can only boost the level of trust patients place in their doctors.”

The Australian Medical Association cautioned against any move that would constrain doctors from fulfilling their ethical obligations to patients. “It’s an individual doctor’s right and responsibility to either see reps or not and, if they actually see reps, to appropriately scrutinise the information given,” said a spokesman for the association, Brian Morton. He added, “It’s up doctors to actually make their own decision and to act appropriately, ethically, and professionally. We have to be careful that we don’t, with rules and regulations, encroach upon that individual doctor’s ethical responsibilities.”

Medicines Australia, which represents the drug industry, said that Australia had one of the toughest codes of conduct in the world on promoting drugs and described No Advertising Please as misguided and dangerous for patients. “The idea that you can ignore information from a pharmaceutical company that has conducted extensive research and development to help treat disease is laughable at best and negligent at worst,” said its chairman, Martin Cross.