Strict conflict-of-interest policies in academic medical centers may help resident physicians resist pharmaceutical company persuasion to prescribe expensive brand-name medications, according to a new study.
Researchers at the University of Pennsylvania’s Perelman School of Medicine analyzed data from 2009 about the antidepressant prescribing patterns of 1652 psychiatrists from 162 US residency programs. “Our study focuses on antidepressants because they have been among the most heavily marketed drug classes,” said lead author Andrew J. Epstein, PhD. He noted that antidepressant use increased by nearly 400% from 1988 to 2008.
Epstein and his colleagues examined data in 2 categories: prescriptions written by physicians who completed their residencies in 2001, before their programs had conflict-of-interest polices in place, and prescriptions from physicians who finished residency training in 2008, after policies had been adopted.
The analysis, which was published online in Medical Care, also evaluated prescription patterns based on how strict the policies were at institutions where the physicians trained. Some policies restricted residents from accepting meals or drug information from pharmaceutical companies. Others extended to faculty and attending physicians by limiting their consulting arrangements with or speaking engagements on behalf of pharmaceutical companies.
Overall, the study showed that the 2008 residency graduates wrote prescriptions for brand-name antidepressants at a lower rate than the 2001 graduates. But the data also showed that the 2008 graduates in training centers with the most restrictive conflict-of-interest policies prescribed brand-name antidepressants at the lowest rate of all the psychiatrists in the study.
“Our results suggest that [conflict-of-interest] policies reduce the appeal of antidepressant medications marketed heavily by pharmaceutical companies,” the researchers wrote. “A shift away from them could help reduce cost growth.”
But the study authors also said restrictive conflict-of-interest policies may have a downside. Residents could miss out on learning how to negotiate relationships with pharmaceutical representatives and physicians might overlook important information about new drugs if contact is limited.