Conflict-of-interest training reduces brand-name antidepressant prescription

uralNews) Doctors who underwent residencies at institutions with conflict-of-interest policies are significantly less likely to prescribe brand name drugs over generics than doctors who underwent residencies at institutions without such policies, according to a study conducted by researchers from the University of Pennsylvania, Yale School of Public Health, Harvard Medical School and Johns Hopkins Bloomberg School of Public Health.

Health professionals and policymakers have expressed growing concern in recent years over the potential for conflicts of interest in relationships between health providers and pharmaceutical or medical device companies. One specific concern was that the gifts the drug companies provide to physicians and physicians in training, including meals and drug samples, could unduly influence those doctors to prescribe those companies' brand-name products even when generic or other lower-cost alternatives exist.

Such concerns spurred a number of institutions to adopt conflict-of-interest policies; Penn Medicine, for example, adopted one in 2006. The Association of American Medical Colleges adopted a broad conflict-of-interest policy in 2008.

The researchers analyzed the prescriptions written in 2009 by 1,652 psychiatrists who had participated in 162 different residency programs; data was obtained from IMS Health. Approximately half of the psychiatrists in the sample had completed their residencies in 2001, when there were nearly no conflict-of-interest policies in place, while the other half had completed their residencies in 2008, after widespread adoption of such policies. The researchers further ranked the psychiatrists based on the strictness of the policies at the institutions they had attended.

"Our study focuses on antidepressants because they have been among the most heavily marketed drug classes," said first author Andrew J. Epstein. "Data show that antidepressant use increased nearly 400 percent from 1988 to 2008. The goal for this study was to determine whether exposure to COI policies during residency would influence psychiatrists' antidepressant prescribing patterns after graduation."

Brand name antidepressants, like drugs from many other classes, are heavily promoted to both consumers and medical professionals. One concern with over-prescription of brand name drugs is that such a practice drives up medical costs for both patients and for public healthcare agencies, such as Medicare.

Policies yield concrete results

Because brand name antidepressants are more expensive, the researchers predicted that psychiatrists with fewer conflicts of interest with drug companies would be more likely to prescribe less expensive, generic drugs. And indeed, the researchers found that psychiatrists who had completed their residency in 2008 prescribed brand name antidepressants at significantly lower rates than those who had finished in 2001. Graduates of 2008 programs with the strictest conflict-of-interest policies had the lowest rates of brand name antidepressant prescription.

The study is the first to provide empirical evidence that conflict-of-interest policies have a real effect on the future prescribing behaviors of medical residents. Epstein noted that further research is now needed to see if the same results can be seen with doctors in different specialties and in different classes of drugs.

"Our study clearly shows that implementation of [conflict-of-interest] policies have helped shield physicians from the often persuasive aspects of pharmaceutical promotion," Epstein said.

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