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Restricting Gifts From Pharma Reps May Change Doctors' Prescribing Habits

A joint study of CMU and six other institutions found that in-person marketing tactics are linked to doctors' prescribing habits.

Hospital policies that restrict how pharmaceutical companies may market their drugs to doctors change physician prescribing behavior, according to a new study published Tuesday in the Journal of the American Medical Association.

The study, a joint effort of Carnegie Mellon University and six other higher education institutions, showed that when such policies were in place, marketed drugs were prescribed 8.7 percent less often while non-marketed drugs were prescribed about 6 percent more often.

The study looked at the policies of 19 different academic medical centers in the U.S. and the prescribing habits of 25,000 physicians with regard to 262 drugs.

In-person marketing of prescription drugs to doctors is common practice, according to CMU economics and psychology professor George Loewenstein, who co-authored the study. The practice is known in the industry as “detailing,” and the marketers themselves as “detailers.” Loewenstein said expensive, name-brand drugs are more likely to be marketed in this way than cheaper, generic alternatives.

Loewenstein said detailers are often attractive and the opposite gender of the doctor, and that “they may be arriving laden with gifts like lunch, not only for the doctor, but for the staff as well.”

Bans on meals and other small gifts were the most common restrictions included in the policies of the 19 medical centers in the study.

The University of Pittsburgh Medical Center’s “industry relations policy,” which covers both pharmaceutical companies and device manufacturers, bans all gifts, including food. It also restricts doctors from taking on “consulting” positions in the industry that do not include substantial job duties, considering those gigs “gifts” as well. Detailers must be specifically invited to visit UPMC facilities and physicians cannot speak at industry-sponsored meetings without approval from management.

“There was a lot of concern about the potential influence of the drug and device industry on the cost and quality of health care,” when the policy was implemented in 2008, said Barbara Barnes, vice president for sponsored programs, research support and continuing medical education at UPMC.

Loewenstein said the study’s results suggest that even small gifts influence physician prescribing behavior, which could hurt patients in the long run. He said patients might end up paying more for name-brand drugs.

“Patients may not be getting the drug that’s best for them and it’s even possible that patients are getting drugs that they shouldn’t be getting at all because the physicians benefit from prescribing those drugs,” Loewenstein said.

Both Loewenstein and Barnes emphasized that the study doesn’t show a definitive causal relationship between detailing policies and prescribing behavior, but it does suggest a strong link.

Additionally, Loewenstein noted that he doesn’t believe physicians’ relationships with pharmaceutical companies and device manufacturers represents the greatest conflict of interest facing health care today. As he and co-author Ian Larkin of the University of California Los Angeles wrote in a JAMA editorial, the fee-for-service model of physician compensation is far more troublesome. Loewenstein and Larkin argued that physicians should instead be compensated with a traditional salary model.

The study was funded by the National institutes of Mental Health and prescription data was provided by CVS Caremark.