There is surprisingly little discussion in the literature about attempts to regulate the behaviour of sales representatives. This suggests that, compared to print and broadcast advertisements, sales representatives’ activities are more difficult to document and study. That also makes them more difficult to regulate.
In Australia, the Australian Pharmaceutical Manufacturers Association has a code of conduct covering sales representatives. Roughead et al.215 looked at whether sales representatives in Australia conform to this. Although the code does not state what kind of information sales representatives must provide, it does insist that their presentations be current, accurate and balanced. Roughead et al. recorded and analysed meetings between sixteen sales representatives and seven GPs. These included 33 presentations of prescription medicines. They found that omission of risk information was common, and that adverse reactions and interactions were mentioned only in statements that minimised the risk of the product being detailed. Thirteen of the 16 presentations included at least one inaccuracy, and four mentioned unapproved indications. This is a really useful study and a simplified version of the method could form the basis of a system for routine monitoring of the quality of representatives’ presentation. A fuller account of the study is available216.
In France, a network of volunteer GPs and specialists monitor the activities of sales representatives. After s/he is visited by a sales representative, each doctor completes a questionnaire on whether the indications and dose regimen given by the sales representative matched the Summary of Product Characteristics (as they are required to); whether contraindications, precautions for use, interactions and adverse effects were mentioned by sales representatives; and the arguments and incentives used. The completed questionnaires are analysed and a summary published in La revue Prescrire. Prescrire International217,218 has discussed these findings and is in English. This is discussed further below (in Monitoring/countering promotion).
At the practice level, Becker et al.’s ethnographic study102 found that practices with policies and guidelines about when sales representatives could visit appeared to find interactions with them more useful and less intrusive.
CONCLUSION: Studies of promotion by drug company representatives suggest that the guidelines and regulations that should control them are not effective.