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 Drugs promoted by pharmaceutical representatives - known as detailed
drugs - lost market share after hospitals enacted such policies,
while drugs that weren't detailed gained market share, researchers
found.
The study's lead author said the findings suggest institutions and
organizations can play a role in relationships between doctors and
the drug industry.
Relying on physicians to manage the appropriateness of those
interactions is a lot to ask, said Ian Larkin, of the University of
California, Los Angeles Anderson School of Management.
In an issue of JAMA devoted to conflicts of interest, Larkin and
colleagues point out that since the start of the 21st century,
industry and academic institutions have adopted policies to regulate
doctor interactions with drug representatives.
Research examining the effect of those policies typically looked at
only one medical specialty and produced mixed results, they add.
For the new study, the researchers examined several sets of data
collected between 2006 and 2012 from academic medical centers in
California, Illinois, Massachusetts, Pennsylvania and New York.
Overall, the researchers had data on more than 15 million
prescriptions written by 2,126 doctors at 19 medical centers. All of
the medical centers had adopted policies that restrict interactions
between doctors and drug representatives.
"These changes are relatively modest, saying you need an appointment
or can’t bring a sandwich," Larkin told Reuters Health.
The researchers analyzed prescribing patterns for eight types of
medications, including drugs to lower cholesterol, treat acid
reflux, control diabetes, manage high blood pressure, treat
attention-deficit/hyperactivity disorder, treat depression, manage
psychosis and help with sleep.
All the drugs had at least 2,000 assigned pharmaceutical company
salespeople during the study period. They also had a market share of
more than 25 percent, but less than 75 percent. The researchers
found 87 of the 262 drugs were detailed during the study period.
Ten to 36 months before the policies were adopted, detailed drugs
had a market share of about 19 percent, compared to about a 14
percent market share for non-detailed drugs.
Twelve to 36 months after the policies were implemented the market
share of detailed drugs fell by about 2 percentage points while the
market share of non-detailed drugs rose about 1 percentage point.
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The reduction in market share for detailed drugs from before and
after the policies were adopted represents about a 9 percent
difference.
Six of the eight drug types had significant changes in market share
over the study period.
Similarly, nine of the medical centers had significant changes in
prescriptions of detailed drugs. Centers that were most likely to
see a change were those that regulated gifts to doctors, restricted
drug representatives' access to the facility and enforced the
policies.
"Our findings suggest that the organizational level can and does
make an important difference," said Larkin.
In an editorial, Colette DeJong and Dr. Adams Dudley of the
University of California, San Francisco Center for Healthcare Value
outlined some benefits and risks tied to interactions between
doctors and drug representatives.
"Detailing" visits from drug representatives are one way to educate
doctors about new drugs and treatments they would need to learn of
elsewhere, they write. But, those visits are linked to increased use
of brand name and costly drugs even when less expensive generic
treatments are available.
"There are feasible alternatives to industry detailing for keeping
physicians informed about drugs, but those approaches are largely
untested in the United States," they write. "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 (conflicts of interests)."
The million dollar question is whether drug detailing and
restrictions on detailing are affecting patient outcomes, Larkin
said.
"I think it’s a really important question," he said.
SOURCE: http://bit.ly/2qpwYzg and http://bit.ly/2qpkhV7 JAMA, online
May 2, 2017.
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