“BANNING PHARMA FROM MED SCHOOL:” Should “patient organizations” do the same?
Posted Feb 01 2013 11:08am
As a “COPD” cohort I am concerned when patient organization’s have direct ties, and associations with Pharma, and endorses every new medication brought to market. It seems to present ethical issues, without an an acceptable answer. The real answer is usually “follow the money.”
Reviewed by Robert Jasmer, MD ; Associate Clinical Professor of Medicine, University of California, San Francisco
Physicians who attended a medical school with a policy that prohibited gifts from drug companies were less likely to prescribe two of three newly marketed psychotropic drugs once they were in practice, researchers found.
Compared with students who graduated 2 years before the policy was implemented, those who attended school with an active gift restriction policy were significantly less likely to prescribe lisdexamfetamine (Vyvanse) over older stimulants (aOR 0.44, 95% CI 0.22 to 0.88, P=0.02) and paliperidone (Invega) over older antipsychotics (aOR 0.25, 95% CI 0.07 to 0.85, P=0.03).
There was no significant difference in prescribing habits for desvenlafaxine (Pristiq) over older antidepressants (aOR 1.54, 95% CI 0.79 to 3.03, P=0.2), Peter Bearman, PhD, of Columbia University in New York City, and colleagues reported online in BMJ.
They also found that the longer a physician was in school while the policy was in effect and the stricter the policy, the lower the likelihood of prescribing the new drug over older ones in that class.
Bearman and colleagues noted that the American Medical Student Association (AMSA) “established a PharmFree Campaign to advocate for evidence based, rather than marketing based prescribing.” AMSA created a rating scale — a PharmFree scorecard — for policies that regulated interactions between students and faculty with pharmaceutical and medical device industry representatives.
The researchers followed prescribing habits of students who graduated before and after the implementation of an active policy that restricted gifts from pharmaceutical and device company representatives at 14 U.S. medical schools. All the policies were adopted by 2004 and students completed residency and were able to independently prescribe medications by July 2008.
The authors measured the likelihood of a physician prescribing a drug approved during the study period in each of three psychotropic drug classes over existing alternatives, and compared the habits of those who had gone to a school with an active gift restriction policy with those who did not.
A second comparison group included students who graduated in 2003 or 2004 and who had not been at school after the policy was instituted.
Physicians who had been students when an active gift restriction policy was in effect were less likely than those not exposed to the policy to prescribe a new stimulant — lisdexamfetamine — over an older approval (5.9% versus 7.4%).
Students exposed to a restriction for longer periods were significantly less likely than those exposed in the main analysis to prescribe the newer stimulant over older ones (aOR 0.21, 95% CI 0.09 to 0.51, P=0.001), as were those with stronger policies than weaker ones (aOR 0.40, 95% CI 0.18 to 0.88, P=0.02).
Results among prescriptions for antipsychotics were similar to those for stimulants. Prescriptions of a new antipsychotic — paliperidone — were more likely to be written by students who were not exposed to a gift restriction policy than by those whose schools had them (1.7% versus 0.5%).
Although strength of gift policies was associated with prescriptions of older antipsychotics over the new drug (aOR 0.21, 95% CI 0.6 to 0.72, P=0.01), there was a nonsignificant trend for exposure time to anti-gifting policies and prescription choice (aOR 0.2, 95% CI 0.04 to 0.96, P=0.05).
Gift policies had no significant effect on prescribing patterns for antidepressants both before and after adjustment and sub-analyses.
The authors concluded that conflict of interest policies “may have the potential to substantially impact clinical practice and reduce prescribing of newly marketed pharmaceuticals” based on outcomes inhibiting medical students from accepting gifts from industry representatives.
They added that future research could examine how policy innovations affect prescribing habits.
They also noted that the study was limited by the window of time in which schools could have adopted the gift-related regulations, the initial nature of many of the 2004 policies, absence of some policy adopters, and missing data for other drug classes.