T o the Editor: In the first study to use identical data collection methods over the same period in three different jurisdictions, Mintzes et al. found that 98 % of the time, pharmaceutical reps failed to provide minimally adequate safety information about drugs to physicians.1 Worse, serious harms were rarely mentioned for drugs identified as harmful, and companies kept promoting them. This represents systematic untruthful abuse of First Amendment commercial free speech.

Patients are harmed. Because numerous studies show that companies bias clinical trials, then further bias published articles about trial results, and bias a third time the marketing material used by drug reps, in order to understate risks of harm, while overstating benefits, prescription drugs have become a major cause of hospitalization, falls, accidents, and death in the United States.2,3 The Food and Drug Administration (FDA) does little to correct this misinformation and allocates only a small fraction of its budget to prevent physicians from receiving inaccurate information about clinical risks of harm. Yet, about 90 % of new pharmaceutical products approved by the FDA each year are judged by independent experts to be little or no better than existing ones.4 Thus, the mission and legal power of prescribing physicians to improve the health of patients is seriously distorted or corrupted, as evidenced by the authors finding that most physicians rate this harm-inducing commercial information as “good or excellent.” When will this risk-proliferating syndrome stop, as it has in the few health care systems where drug reps and free samples are prohibited and replaced by commercial-free information?5 Patients and physicians want superior new drugs whose risks of harm are fully considered, not minor variations with few advantages to offset their hidden risks of harm.