Reconciling a "pleasant exchange" with evidence of information bias: A three-country study on pharmaceutical sales visits in primary care

Health Policy. 2018 Mar;122(3):250-255. doi: 10.1016/j.healthpol.2018.01.010. Epub 2018 Feb 1.


Objectives: To examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing.

Methods: We recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach.

Results: Fifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions.

Conclusions: Physicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs' safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.

Keywords: Focus groups; Health services research; Patient safety; Pharmaceutical policy; Pharmaceutical promotion; Primary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Bias*
  • Canada
  • Commerce*
  • Drug Industry / standards*
  • Drug Prescriptions
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • France
  • Humans
  • Male
  • Marketing
  • Practice Patterns, Physicians'*
  • Primary Health Care*
  • United States

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