Conflict-of-interest policies ‘shield’ trainee doctors from pharma influence

By Caroline Price, Senior medwireNews Reporter

US psychiatrists trained in residency programs with conflict of interest (COI) policies are less likely to prescribe brand antidepressants than those who graduated before such policies were introduced, show study findings.

According to the authors this is the first time such COI policies have been shown to cut down on prescriptions for brand medications, including heavily promoted and brand reformulated drugs.

"Generally the policies adopted didn't include education, but established the barriers to prevent on-campus activities by pharmaceutical sales reps - in particular free lunches, free samples, and detailing opportunities," lead author Andrew Epstein (University of Pennsylvania, Philadelphia) explained to medwireNews.

"If you remove that influence, stop the pharmaceutical representatives at the front door, they are not able to deliver their marketing message," he added.

Epstein and colleagues looked at antidepressant prescribing specifically because this is recognized as one of the most heavily marketed drug types. Data show that antidepressant use increased nearly 400% from 1998 to 2008, they note in Medical Care.

The team used 2009 physician-level prescribing data for 1652 psychiatrists from 162 residency programs, 834 of whom graduated in 2008, after many institutions had adopted COI policies, and 818 of whom graduated before such policies were introduced, in 2001.

They found that rates of prescribing of heavily promoted, brand reformulated, and brand antidepressants were all lower among psychiatrists who graduated in 2008 than those who graduated in 2001.

For example, rates of heavily promoted antidepressants were 14.6%, 15.0%, and 10.0% among 2008 graduates trained in residency programs with minimally, moderately, and maximally restrictive COI policies, respectively. Corresponding rates for the 2001 graduates were 16.4%, 17.6%, and 16.2%.

Further analysis indicated that, compared with 2001 graduates in the same residency group, prescribing rates were lowered significantly further among 2008 graduates of maximally restrictive programs than among those of minimally restrictive programs, by 3.0% for reformulation antidepressants and by 4.5% for brand antidepressants.

The COI policies covered 10 domains, namely gifts, on-site meals, detailing, samples, purchasing and formularies, continuing medical education, consulting, speaking, travel, and industry support for trainees; the researchers judged the degree of restriction according to the American Medical Student Association's PharmFree Scorecard, and the Institute for Medicine as a Profession (IMAP) COI Database at Columbia University.

"We see our paper as establishing for the first time that restrictions on pharmaceutical manufacturers' advertising during training can have lasting effects," Epstein said.

He stressed that having access to information from the pharmaceutical industry could be beneficial for students, and help them prepare for dealing with such relationships once qualified.

Nevertheless, Epstein said: "Our study clearly shows that implementation of COI policies have helped shield physicians from the often persuasive aspects of pharmaceutical promotion."

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