Experience of VA psychiatrists with pharmaceutical detailing of antipsychotic medications
ABSTRACT The interaction between physicians and the pharmaceutical industry has become a subject of increased interest and concern. This study surveyed a national sample of psychiatrists practicing within Department of Veterans Affairs (VA) medical centers in 2005. It specifically focused on the experiences of these physicians with representatives of the manufacturers of second-generation antipsychotics.
VA psychiatrists were invited by e-mail to complete a Web-based questionnaire about their contact with representatives of each of the relevant pharmaceutical companies. Respondents were then questioned about several potential assertions about treatment effectiveness, side effects, and costs of these drugs.
Of the 1,833 potential participants, 639 (35%) visited the Web site and completed the questionnaire. Among the responders, 558 (87%) reported at least one contact with company representatives. In the year before the survey the percentage of respondents reporting contact with representatives of each individual company varied from 58% to 70%. The three most commonly reported assertions made at any time in the past through direct speech during those meetings were that the representative's second-generation antipsychotic resulted in "a decreased risk of extrapyramidal symptoms" (79%), "greater symptom reduction than placebo" (78%), or "better negative symptom control than conventional antipsychotics" (77%). Statements least likely to be reported included that drugs resulted in "better positive symptom control than conventional antipsychotics" (36%), "better positive or negative symptom control than another atypical antipsychotic" (38%), and "increased risk of the development of diabetes mellitus" (39%).
Comparing assertions reportedly made to VA psychiatrists with package insert information suggests that many assertions made by drug company representatives are inconsistent with prescribing information approved by the U.S. Food and Drug Administration, although assertions consistent with package insert information were more common than inconsistent ones.
SourceAvailable from: legacy.signonsandiego.com
[Show abstract] [Hide abstract]
ABSTRACT: Interaction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction. A cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012. A cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats. A total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P < .001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status. Although lower than seen in many parts of the world, a high prevalence of physician-PR inter.action in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.Annals of Saudi medicine 11/2013; 33(6):601-9. DOI:10.5144/0256-4947.2013.601 · 0.71 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: A major problem in the treatment of schizophrenic patients with current antipsychotic drugs, mainly acting as dopamine-2 receptor antagonists, is the occurrence of side effects such as extrapyramidal symptoms (EPS). Meta-analyses of summary data of EPS occurrence, and receptor occupancies inferred from mean plasma concentrations, have shown the incidence of EPS to rise when receptor occupancy is above ~80%. In this analysis, individual longitudinal EPS data from 2,630 patients participating in one of seven different trials and treated with haloperidol, paliperidone, ziprasidone, olanzapine, JNJ-37822681, or placebo were analyzed using a continuous time probability model with Markov elements. The developed pharmacokinetic-pharmacodynamic model describes the longitudinal changes of spontaneously reported EPS-related adverse events and their severity levels rated by clinicians. Individual steady-state concentrations and occupancy levels were found to be predictors for EPS. The results confirm 80% occupancy as a level of increased EPS occurrence rates, also at the individual level.CPT: Pharmacometrics & Systems Pharmacology (2012) 1, e1; doi:10.1038/psp.2012.9; advance online publication 26 September 2012.09/2012; 1(9):e1. DOI:10.1038/psp.2012.9