Restrictions on Pharma Detailing Found to Impact Prescribing Patterns
Abstract
Within a couple of years of policies going into effect, prescribing for drugs that were heavily marketed by detailing declined by 8.7 percent, while prescribing for nondetailed drugs increased by 5.6 percent.
During the past decade, more medical schools and academic medical centers have adopted policies to restrict the traditional marketing tactics employed by the pharmaceutical industry. Such practices—known as “pharmaceutical detailing”—include visits by sales representatives, who hand out gifts to doctors, buy lunch for medical students, and talk about a company’s new FDA-approved drug.
When academic medical centers establish policies to ban or limit detailing to physicians, the heavily marketed drugs are prescribed less, a large study published May 2 in JAMA shows.
This study, led by Ian Larkin, Ph.D., at the University of California, Los Angeles, looked at the prescribing patterns between 2006 and 2012 of over 2,000 physicians at 19 academic medical centers in five states (California, Illinois, Massachusetts, Pennsylvania, and New York), before and after each center implemented conflict-of-interest policies. These policies included prohibiting or putting caps on meals and gifts to physicians and restricting salespersons’ access to patient-care facilities.
To isolate the effect of the conflict-of-interest policies from many other forces that can influence prescribing behaviors, the researchers compared the physicians at the academic medical centers with more than 24,000 physicians in the same geographic area who had similar prescribing habits and were of the same age and specialty, but did not work in an environment with such restrictions.
In the one- to three-year period after the implementation of the academic medical center policies, prescribing for drugs that were heavily marketed by detailing declined by 8.7 percent, while prescribing for nondetailed drugs increased by 5.6 percent. Generic drugs accounted for over 95 percent of the nondetailed drugs.
Eleven of the 19 centers not only restricted gifts to physicians and salesperson access, but also set up mechanisms to penalize physicians and salespersons that violate their policies. At these centers, the change in prescribing patterns was more profound than centers that did not have enforcement mechanisms, the study showed.
Among the drug classes analyzed, sleep aid drugs, drugs for gastroesophageal reflux disease, and attention-deficit/hyperactivity disorder drugs showed the greatest decreases in prescribing following the policy changes, with each decreasing by at least 5 percent, the authors found.
The results of the study complement those of other similar studies, reported the authors. “Future research should examine the relationship between the content of academic medical center detailing policies and the prescribing patterns of physicians, especially because such policies are increasingly being adopted by private medical practices,” they concluded.
“The study by Larkin et al. suggests that the policies physicians and clinical organizations adopt may influence prescribing, which may reduce patients’ out-of-pocket costs,” Colette DeJong, B.A., and R. Adams Dudley, M.D., M.B.A., wrote in a related editorial. “However, restricting interaction between physicians and the pharmaceutical industry without replacing the education about novel drugs that it offers also has possible risks.”
DeJong and Dudley outlined the potential benefits of pharmaceutical detailing before proposing several strategies for addressing conflicts of interest (COIs) related to industry marketing, including the development of an alternative method of drug education.
“There are feasible alternatives to industry detailing for keeping physicians informed about drugs, but those approaches are largely untested in the United States. It has never been more important for physicians to come together to consider these alternatives, generate evidence about their effectiveness, and move the health care system toward solutions that lower costs for patients and minimize COIs,” they concluded.
Since 2007, the American Medical Student Association (AMSA) has been collecting information on conflict-of-interest policies at U.S. medical schools and publishing their evaluation of these policies in a scorecard. The rating system considers many potential conflicts of interest, such as gifts, meals, promotional activities, and financial disclosure requirements.
This work was funded by the National Institute of Mental Health. ■
