• Pharma gift bans for medical students

    Somehow I missed the initial studies, so I’m pleased this news story brought them to my attention:

    The gift restrictions adopted in medical schools and residency programs are linked to less prescribing of brand-name drugs, said two recently published studies that appear to be the first attempts to gauge the clinical practice impact of efforts within medicine to rein in pharma’s influence.

    One study, published Jan. 31 in the British medical journal BMJ, examined the effect of bans on gifts from pharmaceutical companies and device-makers at 14 U.S. medical schools by analyzing the drug orders of about 2,500 doctors. Researchers compared the prescribing practices of physicians trained at those schools after they banned gifts in 2004 with those trained at the same schools before the bans, as well as with a matched set of doctors who attended medical schools that allowed gifts such as industry-funded meals.

    They then looked at how these doctors — 46% general internists, 23% pediatricians, 10% psychiatrists and the remainder practicing other specialties — responded to three new drugs that were marketed in 2008 and 2009.

    The physicians who attended no-gift med schools were 56% less likely than the other doctors to prescribe Shire’s Vyvanse (lisdexamfetamine), a stimulant used to treat attention-deficit/hyperactivity disorder. They also were 75% less likely to order Janssen’s Invega (paliperidone), an antipsychotic. For a third medicine, Pfizer’s antidepressant Pristiq (desvenlafaxine), there was no statistically significant difference in prescribing.

    Another study is cited as well:

    [I]n the February issue of Medical Care looked at the prescribing habits of nearly 1,700 psychiatrists. About half graduated from residency programs in 2001 before gift bans were in vogue, and the other half completed their training in 2008, after many programs banned gifts from industry as part of following the Assn. of American Medical Colleges’ conflict-of-interest guidelines.

    The 2008 graduates were less likely than their 2001 counterparts to prescribe heavily promoted, brand-name antidepressants, the study found. The prescribing gap ranged from 3.6 percentage points to 6.2 percentage points, with stricter residency program rules of conflicts being tied to lower prescribing of the brand-name drugs.

    Here’s a link to the BMJ study. Here’s one to the Medical Care study.

    The impact of the pharmaceutical industry on medical trainees has long been an interest of mine:

    The primary goal of pharmaceutical companies, like all large businesses, is maximization of product sales and profits. Because physicians act as the gatekeepers to prescription drugs, it is no surprise that the majority of pharmaceutical companies’ marketing strategies target physicians. Despite a dramatic increase in direct-to-consumer advertising, ∼90% of the pharmaceutical industry’s $21 billion marketing budget is still aimed at physicians (including residents and medical students). Interactions between pharmaceutical companies and physicians are pervasive and range from seemingly inconsequential exchanges (eg, dispensing inexpensive gifts such as logo-inscribed pens and notepads) to much more significant and potentially problematic interactions (eg, payment of large honoraria to prominent physicians who speak about the merits of a company’s products or payment of trip expenses for physicians who commonly prescribe a company’s products).

    Although the existence of physician–pharmaceutical company interactions is unquestioned, debate continues over whether these interactions actually influence physician behavior, either positively or negatively. Many physicians believe that their interactions with pharmaceutical companies have a positive educational value, and they are confident that their own behavior is in no way influenced by these interactions. However, social science literature has suggested that it would be very unusual if physician behavior was not influenced by both small- and large-scale interactions with pharmaceutical companies. In the past 25 years, 2 reviews of the literature have examined the extent of the physician–pharmaceutical industry interaction and its impact on physician behavior. Both reviews showed strong evidence that physician–pharmaceutical company interactions have a negative impact on physician knowledge, attitude, and behavior.

    That’s from a systematic review I had published in Pediatrics in 2007. You might find that piece interesting as well. It talks about the evidence available to inform educational interventions to affect Industry-Physician relationships. I’m pleased to see the work continues.

    @aaronecarroll

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