Non-steroidal anti-inflammatory drugs (NSAIDs) are used chronically to reduce pain and inflammation in patients with arthritic conditions, and also acutely as analgesics by many patients Both therapeutic and adverse effects of NSAIDs are due to inhibition of cyclooxygenase (COX) enzyme NSAIDs are classified as non-selective and COX-2-selective inhibitors (COXIBS) based on their extent of selectivity for COX inhibition However, regardless of their COX selectivity, reports are still appearing on the GI side effect of NSAIDs particularly on the lower gastrointestinal (GI) tract and the harmful role of their controlled release formulations In addition, previously unpublished data stored in the sponsor’s files, question the GI sparing properties of rofecoxib, a COXIB that has been withdrawn due to cardiovascular (CV) side effects Presently, the major side effects of NSAIDs are the GI complications, renal disturbances and CV events There is a tendency to believe that all NSAIDs are associated with renal and CV side effects, a belief that is not supported by solid evidence Indeed, lower but still therapeutics doses of some NSAIDs may be cardioprotective In this review, we briefly discuss the GI toxicity of the NSAIDs and assess their renal and CV adverse effects in more detail This article is open to POST-PUBLICATION REVIEW  Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page

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Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications.

Background
Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.

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Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review

Importance The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available. Objective To study the association between physicians’ receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries. Design, Setting, and Participants Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 drug classes: statins, cardioselective β-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015. Exposures Receipt of an industry-sponsored meal promoting the drug of interest. Main Outcomes and Measures Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting. Results A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates. Conclusions and Relevance Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2528290/jamainternal_DeJong_2016_oi_160046.pdf

Pharmaceutical industry-sponsored meals and physician prescribing patterns for medicare beneficiaries

Essential medicines for universal health coverage

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1181&context=eastafrica_fhs_mc_paediatr_child_health

Diabetes in sub-Saharan Africa: from clinical care to health policy

Background
Antihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry. Despite strong evidence of the effectiveness and cost-effectiveness of thiazide diuretics, trends in both promotion and prescription of antihypertensive drugs favour newer, less cost-effective agents. Observational evidence shows correlations between exposure to pharmaceutical promotion and less ideal prescribing. Our study therefore aimed to determine whether print advertisements for antihypertensive medications promote quality prescribing in hypertension.

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Do advertisements for antihypertensive drugs in Australia promote quality prescribing? : a cross-sectional study

BACKGROUND An intensive 3-day training programme, the 'Registrar Research Workshop' (RRW), has aimed to build research capacity among Australian general practice registrars since 1994. OBJECTIVES To investigate the impact of the RRW on participants' skills, confidence, interest in research and research activity. METHODS Cross-sectional postal survey in 2006 of five groups of registrars who participated in the annual workshop in 2002-2006 (response rate: 64%; 77 of 121). Outcome measures included research experience and skills prior to and after the workshop; impact of the workshop on capacity, confidence, attitude and interest in research; and research involvement as measured by publications and grant funding. RESULTS Self-reported research skills increased over time for the whole group (two-way analysis of variance: P = 0.047), most significantly for registrars with little or no research experience (P < 0.001) and research project participants (P = 0.003). The impact of the workshop on capacity, confidence and interest in research was rated highly (mean 3.5-4.0 +/- 0.1 on a five-point scale). Two-thirds of the survey respondents had been research active, 34% presented their findings at conferences, 25% published in peer-reviewed journals and 31% received research funding. Eighty-four per cent of respondents indicated a high interest in undertaking research in the future. All survey respondents recommended the workshop to other registrars. CONCLUSIONS The RRW provides a useful model for effective research training for interested general practice trainees. Such training has the potential to increase knowledge of research methods, which might augment future research activity in general practice.

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General Practice research training: impact of the Australian registrar research workshop on research skills, confidence, interest and involvement of participants, 2002-2006

The context of general practice makes the translation of evidence into clinical practice difficult. General practitioners interested in implementing evidence met at The Royal Australian College of General Practitioners' 2006 Annual Scientific Convention. We discussed evidence based medicine (EBM) journal clubs as a solution to this problem, including keys to success and barriers to overcome. The aim of this article is to provide suggestions for those wishing to set up their own EBM journal club. This will be supported as a Category 1 CPD activity by The Royal Australian College of General Practitioners in the 2008-2010 triennium.

EBM journal clubs in general practice

A newspaper article led this general practitioner and his patient to search for evidence and reach a decision on treatment

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Brett D. Montgomery

Papers

Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review

Do advertisements for antihypertensive drugs in Australia promote quality prescribing? : a cross-sectional study

General Practice research training: impact of the Australian registrar research workshop on research skills, confidence, interest and involvement of participants, 2002-2006

EBM journal clubs in general practice

Does paracetamol cause hypertension