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Concern About Drug RepsTo the Editor: As a medical student exposed daily to the entreaties of drug sales representatives, I read with interest the to-and-fro on the industry’s influences on medical practice and research (Mar/Apr 02). Bert Spilker dismisses Howard Brody’s and Paul Jung’s concerns as "the unfounded fears of a few," ignoring the prodigious output of scientific research on this issue.1 For example, Spilker’s assertion that sales representatives may be an important "channel of information" runs contrary to a recent study documenting an 11 percent rate of inaccurate statements made by drug reps during lunch conferences.2 (Not surprisingly, 100 percent of the inaccurate statements were favorable to the drug being promoted.) Spilker also invokes Food and Drug Administration (FDA) regulations and other voluntary guidelines regarding communications between sales reps and physicians. Voluntary guidelines provide some level of guidance for sales reps and physicians, but voluntary communications can go awry.3 Even where the FDA has established explicit standards for quality, deficiencies have been shown to be pervasive. One study that reviewed promotional materials distributed by drug companies judged 35 percent of those materials to be lacking in fair balance.4 This finding is consistent with the results of a study of drug ads in medical journals, which found that 40 percent of reviewed advertisements lacked fair balance.5 If drug promotion serves an educational function, the industry can certainly do better. The literature to date is not perfect but is suggestive enough to make it difficult for Spilker to gainsay, in an evidence-based manner, the critics of such promotional practices.
Medical Student, Case Western Reserve University, Cleveland, Ohio
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