Years ago, after a series of high-profile scandals, teaching hospitals around the country started raising hurdles to pharma reps. Some outright barred salespeople at the door. Others just required appointments.
However they managed it, they apparently changed prescribing habits, too.
That’s the conclusion of a new study, published in the Journal of the American Medical Association, which analyzed before-and-after prescribing behavior among more than 2,000 doctors at 19 different academic medical centers in the U.S.
Drugs promoted by pharma sales reps posted a lower market share (1.67 percentage points) at those 19 hospitals after the policies went into effect. Drugs that weren’t marketed by reps, on the other hand, saw a 0.84 percentage point increase.
The researchers compared scripts written by that group of doctors with those written by a control group of 24,000-plus physicians with unrestricted rep access, focusing on eight drug classes. Before the policies took effect, the mean market share was 19.4% for promoted brands and 14.2% for brands that weren’t promoted.
The shifts didn’t happen at all of the 19 hospitals. While the difference was statistically significant across the board, only 9 among the group saw statistically significant changes individually.
But hospitals that implemented the broadest changes in policy were most likely to see prescribing differences, the study abstract states. Eleven of the 19 hospitals regulated gifts to doctors—some academic medical centers went so far as to stop reps handing out branded ballpoint pens—in addition to restricting access to their facilities and setting up clear enforcement measures.
Prescribing changed significantly at eight of them. By contrast, prescribing shifted at only 1 of the 8 academic medical centers that didn’t impose new hurdles.
Of course, this study only showed an association. Other changes at those hospitals could have triggered the market-share changes. “Nevertheless, the study demonstrates a robust temporal association between pharmaceutical detailing restrictions and prescribing rates of promoted drugs,” an accompanying JAMA editorial stated.
Now, drugmakers could interpret this as further justification for detailing and the attendant expense: As that editorial also points out, the results show that “marketing to physicians increases prescribing of brand-name drugs.”
Other studies have drawn similar conclusions; one controversial analysis showed that free meals boosted branded prescribing, and more expensive meals delivered bigger increases.
Doctors disagree with that conclusion; most say they’re not swayed by marketing, but perhaps by the data and information reps present. Drugmakers contend that detailing offers valuable education, particularly about new meds, and if prescribing goes along with that, then it’s a consequence of that education, not free meals, free pens or personal relationships with reps.
The JAMA editorial offers some backing for that. Doctors can find prescribing information online, but one estimate shows that it takes almost a decade for evidence from reviews, research articles and textbooks to change physician behavior. And other studies have shown that left on their own, doctors are slower to respond to safety warnings.
“Pharmaceutical companies have the resources, national workforce and financial incentive to address this issue, so detailing may accelerate adoption of novel therapies,” the authors wrote.
Then again, they say, detailing can spread inaccurate information, including bad info on rival meds. Other reports have found that reps don’t spend much time discussing potential side effects.
The solution? The JAMA authors don’t have one. Other countries have tried alternative approaches, but they’re “largely untested” in the U.S., they note. For instance, some states have tried sending out their own specially trained medical reps to present evidence on drugs, but budgets are limited and states can’t field anywhere near the number of reps drugmakers can.
"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” potential conflicts,” the editorial states.