CMAJ Open editorial disguised as research

There was an interesting paper in the CMAJ Open that looked at the relationship between drug company promotional spending and therapeutic impact of various drugs. So let’s dive right in. Here is the abstract:

Background:

Whether drug promotion helps or hinders appropriate prescribing by physicians is debated. This study examines the most heavily promoted drugs and the therapeutic value of those drugs to help determine whether doctors should be using promotional material to inform themselves about drugs.

Methods:

Lists were constructed of the 50 most heavily promoted drugs (amount of money spent on journal advertisements and visits by sales representatives) and the 50 top-selling drugs (by dollar value) for 2013, 2014 and 2015. Therapeutic gain was determined by examining ratings from the Patented Medicine Prices Review Board and the French drug bulletin Prescrire International and was categorized as major, moderate or little to none. For each of the 3 years, the number of drugs in the 3 therapeutic categories for drugs in both groups was compared. The amount and proportion of money spent on promotion for drugs in each of the 3 therapeutic categories for the 3 years was also determined.

Results:

Therapeutic ratings were available for 42 of 79 of the most heavily promoted drugs over the 3 years and for 40 of 61 of the top-selling drugs. Nearly all the money spent on promotion in each of the 3 years went to drugs with little to no therapeutic gain. The distribution of therapeutic gain for drugs in both groups was statistically significantly different only in 2013 (p = 0.04).

Interpretation:

Most of the money spent on promotion went to drugs that offer little to no therapeutic gain. This result calls into question whether doctors should read journal advertisements or see sales representatives to acquire information about important medical therapies.

The author, Joel Lexchin, provided links to the resources he used to get ratings on these drugs. I went to those links and couldn't really tell how they determined therapeutic benefit or what determines therapeutic gain. It would be something very difficult to measure because it's a matter of what you value, whether you’re the patient or the clinician. An appendix contains a list of the most highly promoted drugs and their therapeutic ratings. Of interest, NOACs and atorvastatin were rated as providing little or no therapeutic gain. No therapeutic gain from NOACs??? A stretch to say the least. Right there I have to question the relevancy of the findings but to me the larger issue is the author’s conflict of interest. Though purporting to try and answer a research question, he appears to have made up his mind previously. [1] [2] [3] This appears to me to be an attempt to marshal support for a long held position rather than to answer a question. It would have been better to present it as an opinion piece.