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Does pharmaceutical promotion
impact prescribing behavior of doctors?
Research shows that it does
Based on the Congressional
testimony of Michael Wilkes, M.D., Ph.D. Vice Dean, Medical
Education Professor of Medicine and Public Health, University of
California, Davis in front of the Committee on Government Reform
with respect to safety of Vioxx.
This is a difficult area to research but the answer is an unequivocal “yes”. The outcome
that is most important to measure is does the doctor write a prescription for a new product
-- not whether or not she can answer some multiple choice questions. Most doctors are
unaware of how much promotion they are exposed to. Surveys based on self-report are
appropriate for finding out what people think is happening, or how they want to present
themselves, but not what really happens in doctors offices or hospitals. |
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The outcomes that matter in terms of measuring promotion’s effectiveness include:
- Impact of promotion on the doctor’s prescribing behavior,
- Impact of promotion on
overall drug sales, and
- Physician’s requests for additions to the pharmacy formulary.
A useful group of studies look at specific drugs and how they are promoted. From an
industry perspective, a successful promotion results in positive changes in individual
prescribing behavior. Bower and Burkett found that family physicians who reported
relying less on drug sales representatives for information were likely to prescribe more
generic drugs, as were residency trained doctors, and regular readers of weekly medical
journals. Those who engaged in more appropriate and rational prescribing held more
positive attitudes toward generics, and gave other indications of a less positive attitude
towards the industry and promotion, than other doctors. Researcher found that the
answer to a single question (are sales representatives a good sources of prescribing
information about new drugs?) was most predictive of appropriate prescribing.
In summary, there is strong evidence that doctors who rely on promotion as a source of
information about drugs, prescribe more drugs, prescribe less rationally, and prescribe
new drugs earlier than other doctors. Two researchers (Orlowski and Wateska) looked at
the impact of educational symposia on physician prescribing and their report is described
this way.
Using the hospital pharmacy inventory, they tracked the use of two drugs within
one institution 22 months before and 17 months after each symposium about
them. They also collected data on the national usage of these drugs, and
informally interviewed the doctors who had gone to the symposia. Most of the
doctors said that the symposia would not influence their prescribing, but some
said that they might make them think of the drug more and the symposium might
convince them of the benefits of the drug. Orlowski and Wateska found a dramatic
and statistically highly significant increase in the use of the drugs in the hospital
after the relevant symposia. These increases were not reflected in national data,
and they did not seem to affect the hospital's use of alternative drugs. This study
provides evidence firstly, that exposure to promotion increases prescribing, and
secondly that it can do so whether or not those exposed consider themselves
vulnerable to such influence.
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