Intended for healthcare professionals

Rapid response to:

Letters A life free of drug reps

Come into obstetrics

BMJ 2010; 340 doi: (Published 24 March 2010) Cite this as: BMJ 2010;340:c1612

Rapid Response:

Obstetrics is no escape

Atisoban reps were very active before it became standard. It is now
widely used, but no tocolytic has ever been shown to be better than
letting nature take its course in terms of important outcomes such as
perinatal morbidity and mortality. The reps did their work with opinion
leaders and sponsored supplements, now they don't have to try with cheap

Before NICE published their guideline we all used prostaglandin gel
because we believed it to be so much better. Why did we all believe it to
be better than tablets when it was more expensive - was it because the
reps told us so?? When NICE synthesised the evidence it was clear that the
tablets and gel were equally effective. Being out of patent doesn't stop
attempts to develop new formulations.

Reps are not just drugs, but also devices - the Cook's balloon, the
Kiwi cup and Bakri balloons. They may not make pens, but they sponsor
meetings when they so choose.

If O'Hanlon was to come into obstetrics, he would have to do gynae as
well for the first 5 years - so he would have to continue to avoid the
reps with their 'me too' anticholinergic, their '50mg less weight gain'
COC pill etc. How many women got breast cancer because they were started
on HRT after a very convincing drug rep presentation.

Competing interests:
None declared

Competing interests: No competing interests

28 March 2010
Emma Hawkins
Consultant Obstetrician and gynaecologist
BHR Trust, Rom Valley Way Romford RM7 0AG