Pharmaceutical companies' covert promotion of drugs through free medical journals and aggressive marketing tactics affects drug recommendations and can harm patients, according to recently published studies.

"Covert promotion of pharmaceuticals is an important public health issue because it can contribute to the unnecessary overuse of certain drugs or lead to their off-label use without sufficient evidence of efficacy,” Dr. Aaron Kesselheim wrote in a commentary [PDF] published by the Canadian Medical Association Journal (CMAJ).

A study [PDF] published CMAJ in this month found that a medical journal's source of funding affected drug recommendations. Journals that depended entirely on advertising to generate their revenue recommended specific drugs while journals funded solely by subscriptions usually recommended against the use of the same drugs.

Physicians rely on journals to learn about important medical information, such as recommended treatments for diseases.

"Over the past decade, the direct-to-physician promotion of pharmaceuticals has led to the widespread inappropriate use of drugs such as rofecoxib, rosiglitazone and certain anti-psychotic drugs, which in turn has resulted in increased morbidity and mortality for patients," he continued. "Commercial sources of information for these and other products have consistently overstated their benefits and underestimated their risks."

A related study, published in January in the American Journal of Public Health, found drugs that pharmaceutical companies marketed most aggressively to physicians and patients tended to offer less benefits and more harm to patients.

"This is not a random occurrence, but rather a repeating, planned scenario in which drugs, discovered with good science for a specific set of patients, are marketed to a larger population as necessary, beneficial and safer than other alternatives," Howard Brody, a professor and director of the Institute for the Medical Humanities at UTMB Health and co-author of the study, said.

"Marketers are just doing their jobs. However, the reality is that for most new drugs, safety and efficacy are scientifically proven for only a small subset of patients. It’s time for physicians to take a stand and not prescribe them so readily."

Pharmaceutical companies have exaggerated safety and efficacy claims and encouraged unapproved uses of drugs, according to the authors of the study.

For example, a study by researchers at the Stanford University School of Medicine and University of Chicago found a lack strong evidence that atypical antipsychotic medications, a top-selling class of drugs, actually helped most patients. The study was published January 7 in Pharmacoepidemiology and Drug Safety.

"There is an unintended, but direct conflict between pharmaceutical marketing and public health," Brody said. "Physicians should approach commercial marketing by pharmaceutical companies with a critical eye. Future reform polices should look to reduce, minimize and limit these practices. Patients can also play an important role by being more skeptical of drug ads."

Brody and his colleagues said the writing of usage guidelines should be restricted to groups free of commercial conflicts of interest and that research focused on safety and efficacy should be independently funded. In addition, the authors called for a neutral agency, such as a branch of the National Institutes for Health, to conduct drug trials.

"Further funding from governments or other sources not affiliated with the pharmaceutical industry for the development of such information would promote rational prescribing and better outcomes while reducing the need for prescription fees," Kesselheim added. "Most physicians would be happy to receive additional information about the proper use of drugs that is both effective and free of bias, but the medical community needs to do a better job of creating and disseminating this information without the influence of pharmaceutical advertising."