Restricting gifts in medical school influences future prescribing behavior

By Christopher Walsh, medwireNews Reporter

US physicians who attended a medical school with a policy restricting acceptance of gifts from pharmaceutical companies are less likely to prescribe newly marketed drugs than physicians who were not exposed to such restrictions during training, according to research published in the BMJ.

The reduced prescribing rates, which were observed with two of three psychotropic drugs studied, were more pronounced the longer physicians had been exposed to gift-restriction policies, and the more stringent the policies were.

"Our findings suggest that conflict of interest policies… may have the potential to substantially impact clinical practice and reduce prescribing of newly marketed pharmaceuticals," say Peter Bearman (Columbia University, New York, USA) and co-authors.

Between July 2008 and March 2009, physicians who had attended a medical school with an active gift-restriction policy were a significant 56% less likely to prescribe the newly marketed stimulant lisdexamfetamine than were physicians who had not been exposed to a policy, at 5.9% of all stimulant prescriptions versus 7.4%.

Similarly, physicians who had been exposed to a gift-restriction policy were a significant 75% less likely to prescribe the newly marketed antipsychotic paliperidone than were non-restricted physicians, at 0.5% versus 1.7%.

In each of these two drugs classes, longer exposure to gift-restriction policies or exposure to relatively more stringent policies further reduced the rates at which physicians chose the newly marketed medications over older, existing alternatives in the same class.

By contrast, exposure to gift-restriction policies had no effect on the rate at which physicians prescribed the antidepressant desvenlafaxine, and neither the strength nor duration of exposure during medical school had any effect on future prescribing behaviors of this drug class.

The newly marketed medications examined were all reformulations of existing products. Consequently, King and co-authors caution that their findings cannot be extrapolated to infer how gift-restriction policies might influence the adoption of new drugs that are "clear improvements" over existing alternatives. They suggest that such an effect may "slow the diffusion of medical advances."

However, they conclude: "In instances where the newly introduced medication offers no additional benefit to patients, such an effect may limit the unnecessary use of newer, more expensive brand name medications, potentially slowing the escalation of healthcare costs."

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