Choosing Wisely Canada is making an important contribution to ensuring that Canadian doctors use resources in the best interest of their patients’ health. However, one area that has been neglected so far is the influence of the pharmaceutical industry on the way that doctors prescribe. Marketing of drugs such as rofecoxib and long-acting oxycodone has been linked to significant morbidity and mortality. Companies aggressively promote their products to doctors through sales representatives and giving away free samples. Both of these tactics are linked to poorer prescribing. In addition to promotion, companies also influence doctors by controlling the knowledge that doctors receive. Companies are responsible for almost all clinical trials, and their sponsorship is much more likely to produce positive results and conclusions compared to any other source of funding. Financial conflict of interest is widespread in guideline committees that produce Canadian clinical practice guidelines, and the policies that professional medical associations use to guard against commercial bias in the continuing medical education that they sponsor are weak. Overall, the more that doctors rely on information from pharmaceutical companies, the poorer their prescribing. Choosing Wisely Canada needs to expand its mandate to educate doctors about commercial influences.
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