AUTH/3467/2/21 - Anonymous GP v Pfizer

Conduct of a representative

  • Received
    03 February 2021
  • Case number
  • Applicable Code year
  • Completed
    02 July 2021
  • No breach Clause(s)
  • Additional sanctions
  • Appeal
    No appeal

Case Summary

An anonymous, non-contactable complainant who described him/herself as a GP, complained about the promotion of Eliquis (apixaban) by a named Pfizer Limited representative. Eliquis was an anticoagulant indicated for the prevention and treatment of certain thromboembolic events.

The complainant alleged that the representative had disparaged rivaroxaban (marketed as Xarelto by Bayer plc) and claimed that Eliquis had better safety and therefore should be used to address mortality in primary care.

The complainant stated that the quality of representatives had declined which he/she attributed to a lack of training. Any safety data must be balanced and understood by the representative and the complainant alleged an impact on patient safety.

The detailed response from Pfizer is given below.

The Panel noted that the complainant had provided the name of the representative but insufficient information so that the particular circumstances could be clearly identified. Pfizer had identified a possible short conversation that might have led to the complaint. The Panel noted that the representative estimated that the conversation lasted approximately 1.5 minutes.

The Panel noted that while both parties agreed that the representative had referred to both Eliquis and Xarelto, they had differed as to the details of the conversation; it was difficult in such cases to know exactly what had transpired. The complainant alleged that the representative had unfavourably compared Eliquis with Xarelto with regard to safety and stated that because Eliquis had better safety, it therefore should be used to address mortality in primary care. Pfizer had submitted that the representative had noted that NOACs appeared to be widely used in the practice, particularly rivaroxaban, and had only briefly referred to the key outcome data from Granger et al, which had compared Eliquis and warfarin.

The Panel considered that there might have been some confusion as the representative indicated that after he/she had referred to Xarelto use at the practice, he/she had then referred to outcome data from Granger et al which showed a reduction for Eliquis vs warfarin in stroke/systemic embolism, major bleeding and all-cause mortality. The representative stated no other data or claims were made. The Panel queried whether the GP, in such a short exchange, had instead thought that the differences referred to were between Eliquis and Xarelto. It appeared to the Panel that neither the account from the representative nor the submission from Pfizer were clear that the comparator in Granger et al was warfarin.

The training agenda and brief details provided by Pfizer did not appear to put undue emphasis on the side effects of Xarelto.

A judgement had to be made on the available evidence bearing in mind the extreme dissatisfaction usually necessary on the part of an individual before he or she was moved to actually submit a complaint and that the Panel could not contact the complainant for more information. The complainant bore the burden of proof and had to establish his/her case on the balance of probabilities. The Panel did not consider that the complainant had established his/her case that the representative had disparaged Xarelto as alleged and there was no evidence that high standards had not been maintained nor that there was a direct impact on patient safety as alleged. No breach of the Code was ruled including Clause 2