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Does ‘Detailing’ Change Prescribing Behavior? Study Says Yes

LOS ANGELES — Many physicians pooh-pooh the idea that detailing by pharmaceutical sales representatives has much influence on which drugs they prescribe. A new study suggests some of them might be deluding themselves.

The study, published in JAMA, reveals that restricting visits and other activities by drug company salespeople was linked to an 8.7% decrease in the average 19.3% market share of drugs promoted that way.

To reach that conclusion, University of California, Los Angeles-led researchers compared 19 academic medical centers in five U.S. states — all of which had put some restrictions on pharmaceutical representatives' visits to physician offices — to practices without those restrictions.

"No medical center completely barred salesperson visits; salespeople could and did continue to visit physicians at all medical centers in the study," explained lead author Ian Larkin, PhD. "The most common restriction put in place was a ban on meals and other small gifts. The fact that regulating gifts while still allowing sales calls still led to a switch to cheaper, generic drugs may suggest that gifts such as meals play an important role in influencing physicians. The correlation between meals and prescribing has been well established in the literature, but our study suggests this relationship may be causal in nature."

The study suggests that the restrictions might have prompted physicians to opt away from prescribing more expensive patent-protected drugs, and instead write prescriptions for lower-cost generic formulations.

The study involved 25,000 physicians and 262 drugs in eight major drug classes representing more than $60 billion in aggregate sales in the U.S.

"The study cannot definitively prove a causal link between policies that regulated detailing and changes in physician prescribing, but absent a randomized control, this evidence is as definitive as possible," added Larkin, assistant professor of strategy at UCLA's Anderson School of Management. "We investigated 19 different policy implementations that happened over a six-year period, included a control group of highly similar physicians not subject to detailing restrictions, and looked at effects in eight large drug classes. The results were remarkably robust — after the introduction of policies, about five to 10% of physician prescribing behavior changed."