Take a lesson from the drug companies

The authors who recently reviewed the barriers that inhibit the implementation of hypertension management guidelines in Canada1 neglected to mention what might be one of the most important factors: the powerful influence of pharmaceutical manufacturers' marketing campaigns on physician practice patterns.2 The freebie phenomenon was addressed in a news item in the same issue of CMAJ in which the review appeared.3 Flip through the pages of that particular issue and you will come across 5 glossy advertisements promoting angiotensin-converting-enzyme inhibitors or AT₁ receptor blockers in the treatment of hypertension. Clinical practice guidelines are reflected only in footnotes in tiny print stating that the drugs being advertised are indicated when treatment with diuretics or β-blockers is ineffective or not appropriate.

If the groups that create clinical practice guidelines are wondering how to influence physicians' practices more effectively across the country, perhaps they should take a lesson from the drug companies: give out lots of free samples and promotional items, host elaborate events at which physicians are told about the excellent safety and tolerability profiles of the recommended drugs and place glossy 2-page ads in each issue of CMAJ. Apparently, it works.