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Does industry-sponsored education foster overdiagnosis and overtreatment of depression, osteoporosis and over­active bladder syndrome? An Australian cohort study
  1. Barbara Mintzes1,
  2. Swestika Swandari2,
  3. Alice Fabbri1,3,
  4. Quinn Grundy1,
  5. Ray Moynihan4,
  6. Lisa Bero1
  1. 1 Charles Perkins Centre and Faculty of Pharmacy, University of Sydney, Camperdown, NSW, Australia
  2. 2 Makassar Health Training Centre, Ministry of Health, Makassar, Indonesia
  3. 3 Centre for Research in Medical Pharmacology, University of Insubria, Varese, Italy
  4. 4 Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
  1. Correspondence to Dr Barbara Mintzes; barbara.mintzes{at}sydney.edu.au

Abstract

Objectives To investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment.

Design and setting This retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events. We hypothesised that companies marketing treatments for each condition would sponsor related events and that target audiences would mainly work in primary care, reflecting a broad patient population.

Main outcome measures Event and attendee characteristics, sponsoring companies, related marketed treatments, cost-effectiveness ratings and dispensing rates.

Results Over the study period, we identified 1567 events focusing on depression, 1375 on osteoporosis and 190 on overactive bladder (total n=3132, with 96 660 attendees). These events were attended by primary care doctors more often than sponsored events without a focus on these three conditions: relative risk (RR)=3.06 (95% CI 2.81 to 3.32) for depression, RR=1.48 (95% CI 1.41 to 1.55) for osteoporosis and RR=2.59 (95% CI 2.09 to 3.21) for overactive bladder. Servier, which markets agomelatine and AstraZeneca (quetiapine) sponsored 51.2% and 23.0% of depression events, respectively. Amgen and GlaxoSmithKline, which co-market denosumab, sponsored 49.5% of osteoporosis events and Astellas and Commonwealth Serum Laboratories (CSL) (mirabegron and solifenacin) sponsored 80.5% of overactive bladder events.

Conclusions This 4-year overview of industry-sponsored events on three overdiagnosed and overtreated conditions found that primary care clinicians were often targeted, dinner was often provided and that a few companies sponsored most events. In most cases, sponsors’ products are not cost-effective choices for the specified condition. This pattern highlights the need for professional education to be free of commercial sponsorship.

  • health policy
  • quality in health care
  • urinary incontinences
  • musculoskeletal disorders

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors BM initiated the study, designed the data coding approach and plans for analysis, assisted with the development of the coding scheme, carried out analyses and drafted and revised the paper. She is the guarantor. SS and AF contributed to the study design and coding scheme, carried out data coding and analysis and revised the draft paper. QG, RM and LB contributed to the study design and coding scheme and revised the draft paper.

  • Funding Faculty of Pharmacy, The University of Sydney, provided summer scholarship funding for SS for the work contributed to this study.

  • Competing interests BM reported that she was an expert witness on behalf of plaintiffs in a Canadian class action suit concerning cardiovascular risks of a testosterone gel.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data have been made publicly available and can be accessed at http://dx.doi.org/10.4227/11/592631edbd9d5.

  • Open data All data have been made publicly available and can be accessed at http://dx.doi.org/10.4227/11/592631edbd9d5.

  • Presented at Preliminary study results were presented at the Preventing Overdiagnosis Conference in Barcelona, Spain, September 2016.

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