I'll prescribe it if you do: Prescribers susceptible to peer pressure, study finds

Like teenage girls unsure of the latest fashion, doctors are susceptible to the social influence of their peers when it comes to prescribing both new and repeat drugs, according to a new Wharton School study. And not unlike said teens, peer influencers change over time. With doctors, however, the study found that the changes occur as a drug moves from new and risky to recurrent status.

The Wharton professors divided doctors' influencer colleagues into two groups: those who are "co-located," whether that meant partners in a practice or colleagues at a larger medical facility, and those who are "networked neighbors" or fellow doctors who are part of a wider network used when seeking consultations or advice.

Raghuram Iyengar

While both groups were very influential in determining whether a doctor will initially prescribe a drug, only the co-located physicians continued to hold sway on whether the doctor would continue to write the prescription, said Raghuram Iyengar, associate professor of marketing at University of Pennsylvania's Wharton School and coauthor of the report, published recently in Informs' Marketing Science.

Using physician surveys about self-perception, the study also determined which doctors are most susceptible to influence. Not surprisingly, less confident people who don't perceive themselves as leaders and who tend to ask others for advice were more vulnerable to influence when it came to prescribing a new drug.

However, when it came to represcribing, it was the doctors in the middle--those of average influence and status--who were the most vulnerable to local influencers, Iyengar told FiercePharmaMarketing. That means that the average status doctors inside a large healthcare facility or research hospital would more likely represcribe a drug if they knew that others on their co-located site were also prescribing it, he said. Partner doctors in a small practice would likely know what others are prescribing, but in big facilities that would be less likely.

Iyengar said the findings mean that pharma should be shifting marketing strategies as a drug moves through trial to repeat use. Targeting influencers works as an initial strategy, but moving down the physician influence chain when the drug is up for repeated use is a better second-line strategy.

Messaging should evolve as well, he said. Move away from the risk-assessment rhetoric of new drugs to reassurances that others in the same system are using it. It is that normative pressure, or the influence to believe that something is "the right thing to do," that can work as simply as letting doctors know that a particular drug has become the norm in their local hospital system.

The research was conducted following one drug that Iyengar could only describe as a chronic disease drug because of a nondisclosure agreement.

Still, "I do think this holds true for many other drugs, especially those prescribed for chronic disease when doctors may not see a huge change in a patient's condition," he said, noting that in that case, a doctor wavering on represcribing is more likely to follow the normative or conforming route.

- see the Wharton report