When pharmaceutical sales representatives are far from them in teaching hospitals, doctors have the tendency to prescribe fewer brand-name drugs and use more generic versions, according to a new study.
The results were notable when compared with the prescribing habits of doctors in hospitals where medical reps were not prohibited from accessing them or offering gift items, the research further revealed.
Less Access To Doctors, Fewer Brand-Name Prescriptions
Pharmaceutical companies commonly promote medications to doctors during sales visits, which may involve offering gifts such as free meals and samples. The practice is known as “detailing.”
“There has long been concern that drug marketing to physicians might influence their prescribing, including — and maybe especially — for psychiatric drugs,” said Michael Schoenbaum, study author and a scientist at the National Institute of Mental Health, in a statement.
Conflicts of interest have existed in the medical field, but recent crackdowns by academic medical centers as well as a couple of lawsuits have turned the attention back to how these relationships between doctors and pharma reps affect prescribing.
The new teaching hospital study covered January 2006 to June 2012 and 19 centers across five U.S. states, where drug reps’ visits were limited or restricted in various ways. The team then compared prescriptions from over 2,000 doctors from those centers with more than 24,000 peers with similar traits who were not subjected to the same limits.
More than 16 million prescriptions were included in the analysis, encompassing major drug classes including lipid-lowering drugs, gastroesophageal reflux disease drugs, anti-diabetic agents, antihypertensive drugs, sleep aids, attention deficit hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs.
The findings: policies governing detailing were linked to a 1.67 percentage point reduction in market share for the average promoted medication. Prior to these rules, the average drug landed a 19.3 percent market share.
The decline in prescriptions of detailed drugs was most significant at centers with the strictest policies, including banning sales reps in patient care segments as well as slapping penalties for violators.
The market share of prescribed non-detailed drugs, on the other hand, climbed 0.84 percentage point, or a relative 5.6 percent increase.
How Policy Restricting 'Detailing’ Affects Prescribing
"These weren't terribly onerous restrictions, yet at the same time, they changed prescribing in a way that has really significant cost implications," said Ian Larkin, study author and assistant professor of strategy at UCLA.
Stanford University, among the early adopters of restrictive policies on detailing, was among the centers that did not reflect statistically significant changes. Back in 2010, ProPublica – which has tracked payments to doctors for the last 6.5 years – disclosed how Stanford was hardly enforcing its rules, and from there Stanford doctors prescribed fewer promoted medications but with less-than-significant results.
Some teaching hospitals had policies in place but with less impact than the researchers thought, Larkin added.
An accompanying editorial recommended alternative ways to educate physicians on drugs besides a general dependence on pharmaceutical company promotions. Patient costs can be lowered and conflicts of interest can be minimized when these alternatives are considered, wrote UC San Francisco’s Colette DeJong and Dr. R. Adams.
The findings have been discussed in the journal JAMA.