Unlike medical publications that require paid subscriptions, free journals get most or all of their funding from pharmaceutical advertising.

A group of researchers keen to discover what effect industry ties have on the content of published medical journals conducted a detailed comparison of journals that are free, those that have some pharmaceutical advertising and subscription fees, and those that are subscription-only.

Their findings, published on Monday in the Canadian Medical Association Journal, show that free journals are much more likely than other publications to display ads for new drugs that are more expensive than older, generic versions as well as drugs that are linked to some concerns over effectiveness.

But the researchers also discovered that free journals frequently print editorial content that directly recommends the drugs that are advertised in the journal.

“It’s pretty well drug company advertising,” said Joel Lexchin, a professor in the School of Health Policy & Management [Faculty of Health] at �첥��Ƶ in Toronto and one of the study’s authors. “These journals probably have a role in influencing prescribing behaviour.”

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Health Canada and Paladin Labs Inc. announced a recall Wednesday of Darvon-N, the brand name of dextropropoxyphene, also known as propoxyphene, after new research showed the drug is linked to serious abnormal heart rhythms. The announcement came less than two weeks after the US Food and Drug Administration decided the drug should be removed from the market.

But widespread safety concerns about the drug have actually been around for decades, and prompted Britain and the European Union to ban Darvon-N amid fears it was linked to suicide and accidental overdose.

Joel Lexchin, a professor in York’s School of Health Policy & Management, said should have taken an active role with respect to Darvon-N, as well as other drugs. The department's follow-the-leader behaviour exposes major shortcomings and weaknesses in its drug monitoring capabilities, he said.

"This drug should have been off the market 30 years ago," Lexchin said in an interview Thursday. "Unfortunately, it took this long to get it off the market."

Health Canada should beef up its system for monitoring the safety of drugs as well as tracking the number of patients who experience serious side effects, he said.

Lexchin is a co-author of , which calls for sweeping improvements to drug safety in Canada.

Posted by Elizabeth Monier-Williams, research communications officer, with files courtesy of YFile– �첥��Ƶ’s daily e-bulletin.

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The findings, published Wednesday in the journal, PLoS Medicine, offer a broad look at the relationship between doctors’ prescribing habits and their exposure to information provided by drug companies. Researchers analyzed 58 separate studies of this phenomenon from Canada, the United States, Europe and Australia, dating from the 1960s.

Left: Joel Lexchin

“Many doctors claim they aren’t influenced by the information provided by pharmaceutical companies. Our research clearly shows that they are – and the influence is negative,” says Lexchin, a professor in the School of Health Policy & Management in York’s and an emergency physician in Toronto.

“Unfortunately, patients are the ones getting a raw deal. If doctors are inundated with advertising from brand- name companies, they are more likely to prescribe that brand name, regardless of whether it’s best for the patient.”

All but one of the studies suggested that exposure to promotional information was associated with lower prescribing quality; the one remaining study detected no association. Findings also show that promotional information led to more frequent prescribing; studies dealing with this correlation either showed a spike in prescribing or detected no association. Researchers also established a link between promotion and higher prescribing costs.

Lexchin says Canadian drug companies spend big money on marketing their products to physicians, to the detriment of other priorities such as research and development.

“In Canada, companies are estimated to be spending anywhere between $2.4 and $4.75 billion annually on promotion, one of the major reasons why spending on brand-name drugs was rising at a rate of just under 10 per cent annually until two years ago,” he says.

A limitation of the research is that most studies were observational in nature, meaning that the majority of physicians who participated were not randomly selected.

The researchers found no evidence that drug companies' promotional efforts improve prescribing behaviour in any way, but, says Lexchin, “that doesn’t entirely exclude the possibility that prescribing might sometimes be improved.” However, he adds, "As a precaution, we recommend that physicians avoid exposure to the information provided by pharmaceutical companies.”

The study, “Information from pharmaceutical companies and the quality, quantity and cost of physicians’ prescribing: a systematic review”, was led by Geoffrey Spurling, a professor at the University of Queensland, Brisbane, Australia. To read it, visit the website.

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In a paper produced by the , Dr. Joel Lexchin writes that while some drugs will always pose risks for some people, it is Health Canada’s job to identify as many potential problems as possible before drugs are approved for sale, to monitor them once they are approved, and to communicate any new safety information about them effectively.

The agency has neither abandoned those responsibilities, nor is it embracing them, the report states. “If we want to ensure that drugs are prescribed and used as safely as possible, then needs to reorient its priorities,” Lexchin said in an interview. “There are things it could be doing right now that it’s not doing.”

Lexchin, an emergency room doctor who teaches in �첥��Ƶ’s School of Health Policy & Management in the Faculty of Health, said there is too much emphasis on getting drugs on the market quickly, and that the financial penalties levied on the department for not meeting time targets – 180 days for reviewing drugs identified as priority drugs and 300 for non-priority drugs – are problematic. “When you’re faced with that kind of thing, people are operating under pressure and they may not do as thorough a job as they think they need to,” said Lexchin.

The majority of Health Canada employees do a good job, he said, but it’s a lack of political will to make the drug regulation system safer and more effective that is at issue.

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