Doctors prescribe more generics when medical reps kept at bay

A study published yesterday in JAMA, the journal of the American Medical Association, revealed that when teaching hospitals put pharmaceutical sales representatives on a tighter leash, their doctors were inclined to prescribe fewer promoted brand-name drugs and use more generic versions.

The results are significant compared with doctors who worked at hospitals that allowed sales reps to freely roam around offering meals or gifts, according to research by Ian Larkin, an assistant professor of strategy at the University of California, Los Angeles Anderson School of Management, and colleagues.

This issue of JAMA focused on conflicts of interest in medicine and included a viewpoint on what ProPublica, a US non-profit organisation investigative and public interest on-profit, had learned by publishing Dollars for Docs, a tool that allowed users to look up their physicians' payments from drug and medical device companies.

Conflicts of interest in medicine had been common for years, but after lawsuits, coupled with a crackdown by medical centres and public disclosure  of industry payments, there is now a renewed focus on how these relationships affected prescribing.

ProPublica, which had tracked payments to doctors for the past six and a half years, found that some practitioners earned hundreds of thousands of dollars or more each year working with drug and device companies.

The JAMA study also showed that when academic medical centres placed limits on the gifts pharmaceutical sales reps could give doctors and the time they could spend with them, an immediate decline in the market share of the drugs they were pushing was seen.

The impact of the effect, while modest in percentage terms, implied that the work of pharmaceutical sales representatives and the gifts offered produced billions of dollars in extra revenues for drug companies.