More training might be needed on industry gifts

Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications, according to a recent study.1 Physicians who attended a medical school with an active conflict-of-interest policy were less likely to prescribe lisdexamfetamine over older stimulants and paliperidone over older antipsychotics. Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced.

“We were surprised by the large effect sizes we observed. While we had anticipated that the policies would have some effect on physician prescribing practices, we did not anticipate them having as large of an effect as they did,” says Marissa King, PhD, the study’s lead author and assistant professor of organizational behavior at Yale University School of Management in New Haven, CT.

Pharmaceutical companies have clear incentives to encourage physicians to adopt and prescribe their products, which are not aligned with the goal of providing an unbiased education, notes King. “Therefore, there is little role for pharmaceutical companies in early physician education,” she says. If medical schools are committed to providing an unbiased education, they should implement comprehensive policies to limit interactions between pharmaceutical companies and aspiring physicians, she argues.

“Ideally, ethics education should be a part of comprehensive conflict of interest policies,” says King. “Once physicians leave the academy, it is important that they have the tools to address negative potential conflicts of interest that arise when interacting with industry representatives.”

Physicians have an obligation to seek to optimize the health of their patients, and clinical decisions should be based on sound evidence-based science rather than information provided by industry representatives or sources that have an interest in maximizing the use of their products, argues Douglas S. Diekema, MD, MPH, an attending physician in the ED at Seattle Children’s Hospital and director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle (WA) Children’s Research Institute.

“Medical students, residents, and practicing physicians should be aware of the many ways in which industry attempts to influence their clinical decision-making,” he says.

This occurs not simply in the form of gifts, but by way of research grants, consultation opportunities, invitations to industry sponsored events, including CME events, and even some published articles that appear in the medical literature, says Diekema.

“Physicians have an obligation to be aware of these practices, to be aware of how easily they can be influenced, and to be on guard against that influence,” he adds. “Training programs should include educational programming that focuses on these issues.”

Reference

1. King M, Essick C, Bearman P, et al. Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: Difference-in-differences analysis. BMJ 2013;346:f264

Sources

• Douglas S. Diekema, MD, MPH, Treuman Katz Center for Pediatric Bioethics, Seattle (WA) Children’s Research Institute. Phone: (206) 987-4346. E-mail: diek@u.washington.edu.

• Marissa King, PhD, Assistant Professor of Organizational Behavior, Yale University School of Management, New Haven, CT. Phone: (646) 573-3290. E-mail: marissa.king@yale.edu.