General practitioners get lots of mail

At the top of my batch yesterday was a shiny green pamphlet that simply asked "Who's really at risk of contracting hepatitis B?" It smelt like advertising so I cast it aside to open later.

Next up came a letter from a local dermatologist who wrote that my patient had been prescribed a particular brand-name cream. I couldn't recall its active ingredient and flung the correspondence onto a check-my-facts pile, while quickly repressing the thought that this mightn't have been necessary if I saw pharmaceutical company representatives or read drug ads.

Opening the next letter caused a distinct surge of relief. By strange serendipity it was about the very same cream. I wouldn't need to check anything!

On closer inspection, the letter proved to be an apology from the manufacturer for "misleading and unbalanced" promotion of the drug. Maybe the dermatologist had facts to check too.

I figured, not for the first time, that it's just as well I avoid drug reps-I can't expect myself to filter expert propaganda from corporations richer than many countries.

Even Gardasil, the genital wart virus immunisation typically requested by young female patients as "the cervical cancer vaccine", is more than just an Australian scientific success story. It's a marketing juggernaut.

So much so, that the Federal Opposition attacked the government for pausing the vaccine's rollout during price negotiations. Of course, haggling over the cost was only needed because the developer, Commonwealth Serum Laboratories, had been flogged off during a 1990's government sale of family silver. This privatised profits and CSL's share price has increased nearly ten-fold during the biotech boom in recent years ... but that's another story.

Like many GPs, I'm currently doling out taxpayer-funded Gardasil vaccines as fast as stocks arrive-but that doesn't mean my only concern has been the more-painful-than-average injections.

Qualms about Gardasil initially seemed unpatriotic or even misogynistic. Misgivings are now common, and include its cost, its marketing as the solution to cancer of the cervix when at best it's expected to prevent about two-thirds of cases, the incorrect and dangerous perception that it might make Pap smears unnecessary, and the difficult question of the best age to give a vaccine whose effect might yet prove to wear off before many recipients even start having sex.

Thing are often more complex than they seem. Some years ago there was a campaign, apparently initiated by a patient support group, to caution against generic prescriptions of anti-epileptic drugs. The concern was that subtle differences in bioavailability compared with more expensive brand name drugs could cause fitting.

The media and experts at the time seemed to overlook that severe epileptics are often stabilised in public hospitals, so I made a few phone calls. It turned out that public hospitals used cheap generic drugs. Contrary to the well-funded campaign, it seemed prescribing brand name drugs might be dangerous!

I then tried to speak to the neurology professor making media appearances to raise awareness of the possible hazards of generics. I didn't get past his secretary but asked her if the Prof was a drug company lackey. For some reason, she thought I was joking.

Industry relationships are claimed to be educational so it's recently been suggested that doctors attending drug company events should be publicly identified. The professor chairing the Australian Medical Association's Therapeutics Committee commented that this would be "a major tragedy". He might be supported by the 27 per cent of US medical school and major teaching hospital departmental heads who are also paid consultants to the pharmaceutical industry.

Fortunately, the pendulum in medical circles seems to be swinging away from the solicitations of Big Pharma. These days, refusing to see drug reps is often regarded as endearing eccentricity rather than dubious weirdness.

Amid squeals and to their credit, a number of Australian medical colleges have released tougher recommendations for dealing with my profession's corporate sponsors. This is probably just as well when block-buster drugs like Vioxx are regularly busted by trials or meta-analyses.

Of course, even a meta-analysis isn't always what it seems. A recent review found that those funded by pharmaceutical companies, compared with those done without industry support, are less transparent with fewer reservations about methodological limitations of the included trials, and have more favourable conclusions than the corresponding Cochrane reviews.

Anyway, back to the question of "Who's really at risk of contracting hep B?" A quick squiz inside the pamphlet has just revealed the inconvenient truth - it's nubile women in bikinis.