Accentuate the Positive, Eliminate the Negative

All salespeople know that to increase business, you must, as the old song goes, “accentuate the positive and eliminate the negative” attributes of the product you are peddling. This is no less true for those in the field of prescription drug sales, often called drug sales reps. Unfortunately, when this practice is applied to pharmaceutical sales, it could result in harm to patients.

A well-designed study has just been published in the Journal of General Internal Medicine involving a total of 255 primary care doctors in the U.S. (Sacramento), Canada (Vancouver and Montreal) and France (Toulouse) and using 1,692 different interactions between the doctors and drug sales reps. In each of these sales visits, doctors recorded information about the content of the sales pitch, in terms of the stated benefits and risks of each specific drug. The study researchers, knowing the objective information about the drugs, rated the sales pitches based on the adequacy of the benefit and risk information the reps provided.

Alarmingly, the researchers deemed an overall total of only 1.7 percent of the interactions as providing “minimally adequate” safety information. The researchers also found that the reps disclosed information on benefits twice as often as information on risks. In more than half of the interactions from the three North American sites, not one single mention was made of the negative effects of the drugs being sold. Furthermore,the article notes, “serious adverse events were rarely mentioned (5–6 % of promotions in all four sites), although 45 percent of promotions were for drugs with U.S. Food and Drug Administration (FDA) ‘black box’ warnings of serious risks.”

As an example, rosiglitazone (AVANDIA) is a drug Public Citizen asked the FDA to ban several years ago due to increased risks of heart attack and other cardiac toxicity. It was subsequently banned in Europe but, because of lax North American regulations, is still in limited use in the U.S. and Canada. Describing this dangerous drug, drug reps told doctors that “AVANDIA is not as dangerous as the public makes it out to be” (in Sacramento) and “new studies indicate safety” (in Vancouver).

Equally troubling, the physicians themselves concluded that the quality of scientific information provided to them was good or excellent in roughly half of the promotions, indicating a willingness to prescribe the specific drug 64 percent of the time.

For drug reps, the “accentuate the positive” approach to pushing drugs onto often ill-informed physicians clearly works. For patients, it could result in harm or even death. Ask your physician if she or he still sees drug reps. If the answer is yes, you might gently suggest a change of habit — for your benefit, as well as all of the other patients in the practice.