Polite Dissent

Daily, we have pharmaceutical representatives (hereafter called “drug reps”) stop by our office to talk to my partner or me. Their job is to convince us that their drug is best, and we should prescribe it above all others (a tough job, as I almost always prescribe time-tested and trusted generics).

They also bring samples of their medication for us to hand out. This is important, especially for our low-income or elderly patients.

To convince us to use their drugs, they will bring out charts and reports and studies to prove their point. Unfortunately, I find that many of these studies and reports are flawed, biased, or both.

I don’t blame the drug reps for the bad data (because it’s provided by their home office), but I will take the time to make them sweat and squirm about it.

I simply cannot stand misleading statistics. I find it unethical and immoral to intentionally mislead people. Most individuals, even educated ones, are surprisingly naﶥ about statistics, and don’t realize how easy it is for them to be misled. It’s not just physicians who need to be wary of bad data, but the public as well. Most of these studies also show up in television and print ads for the medications.

Here are some common situations:

1. Unequal Comparisons: Yesterday, a rep pulled out a graph showing 10 mg of his statin (a type of cholesterol drug) compared to 10 mg of all the other statins. According to the chart, his drug was far above the rest. Impressive? Not really, because the comparison was very misleading. 10 mg of his drug is its standard dose, but 10 mg of the other drugs are only half-strength or quarter-strength doses, so of course his drug came out on top. It’s like taking a full shot of Jack Daniels, a watered-down shot of Jim Beam and a watered-down shot of Wild Turkey and asking which is stronger.
   Unfortunately this is a very common tactic: studies that compare a high dose of one drug against weaker doses of its competitors.
2. Differing Definitions: There are three main osteoporosis drugs. Each one claims that they are the best, but each drug measures “best” differently – one measures bone density, one measures hip fractures, and one measures spinal compression fractures. It’s nearly impossible to effectively compare drugs when each company defines the solution to best fit their specific product. Which is best? It’s not clear, but I have my suspicions.
3. Anecdotal Evidence: One of the drug reps loves to use anecdotal evidence provided by a local cardiologist. “Dr. McE- put this patient on our drug and their cholesterol dropped by one-hundred points!”
   Anecdotal evidence is fine to illustrate a point, but it carries very little weight. It is the weakest type of evidence; it is the statistical equivalent of a story your cousin’s neighbor’s hairdresser’s son told. Drug reps know this, yet some continue to present anecdotal evidence as if it were better than real scientific studies. (Note that this is the same trick most weight loss drug/diet ads use, with the small-print disclaimer “results not typical”.)

Let it be stated that I like the drug reps individually and socially; I’m just not fond of their job and the tricks some use.