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40 years without sales representatives

 Editorial  One method used by companies to promote their health products is through sales representatives who meet with healthcare professionals at their place of work, otherwise known as detailing. Prescrire has been documenting the harmful effects of the biased information spread through this practice and its impact on prescribing for 40 years now. 
Full article available for download (free)

40 years, this more or less corresponds to the length of a healthcare professional's career. Many healthcare professionals come up with "good" reasons for agreeing to meet with these travelling salespeople, such as: "It's been going on for a long time, and all my colleagues do it", or "A little gift is always welcome", or "I don't want to be part of the reason these people lose their jobs". You may also hear them say "I need to meet with sales reps so that I can learn about new drugs" or "I am quite capable of guiding our interactions without being influenced".

But they are deluding themselves! The marketing techniques used by sales representatives have been shown to influence our prescribing behaviour and the advice we give, even when we believe that we have sufficient critical capacity to resist (e.g. see "The mechanisms behind influence and persuasion", Prescrire Int n° 197,  subscribers only). In its French edition, Prescrire has long encouraged the many healthcare professionals who prefer to no longer meet with sales representatives, challenging readers, back in 1990, to give it up for a year ("One year without sales representatives" Rev Prescrire September 1990, in French). And a Prescrire network set up in France to monitor representatives' sales pitches showed that they have no educational value and are a harmful influence on health professionals' continuing professional development ("15 years of monitoring and one simple conclusion: don't expect sales representatives to help improve healthcare quality", Prescrire Int n° 84, free).

In late 2022, France's National Authority for Health (HAS) reported that health professionals are heavily exposed to pharmaceutical detailing, that the information provided is of very poor quality, and that it greatly affects professional practice. It further noted that action taken by various governments to regulate pharmaceutical detailing has had only modest efficacy or has been poorly evaluated (see "Don't expect anything useful from sales representatives in 2023, also according to the HAS" Rev Prescrire n° 483, in French).

Under these circumstances, the most immediate and effective solution is to take individual action, rather than waiting for institutions or regulators to intervene. There are major benefits to be had from refusing to meet with sales representatives, and joining the one-tenth to one-third of doctors who, according to international studies, have already done so with no regrets. There are benefits for patients and public health because health products are more thoughtfully chosen and used, free from direct commercial influence. There are considerable professional benefits as well. The time saved can be used to better meet patients' needs, to engage in continuing professional development using reliable sources of our own choosing, or to take time out. And we are better able to think for ourselves and to see through and resist other channels of corporate influence.

©Prescrire 1 March 2024

Source: "40 years without sales representatives" Prescrire Int 2024; 33 (257): 59. Free.

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