Doctors at teaching hospitals are more likely to prescribe generic drugs over name-brand ones when pharmaceutical sales representatives are kept at bay, a study published in JAMA shows. 
By comparison, doctors working in hospitals that don’t keep pharma sales reps on a short leash – freely accepting meals and gifts, and letting reps have free reign of the hospital – prescribed far more name-brand medications.
In other words, pharma reps know how to sweet-talk docs into choosing significantly more expensive drugs over cheaper generics.
Findings of the Study
For the teaching hospital study, researchers looked at 19 centers in 5 states that restricted visits by drug reps by:
- limiting access
- limiting gifts
- or punishing reps who broke the rules
The team compared prescriptions by 2,126 doctors at teaching hospitals with 24,593 of their peers with similar characteristics who did not limit reps’ access. The study also examined more than 16 million prescriptions in total, using data from CVS Caremark, a large pharmacy benefit manager.
In an editorial accompanying the study, Charles Ornstein, from ProPublica, writes:
“Understanding the financial relationships between physicians and the drug industry is only 1 window into prescribing habits. It is just as important, if not more so, to understand how prescribing practices of physicians compare with their peers. Most physicians generally are not aware if their drug choices are similar to other physicians in their fields; there has been no definition of what constitutes ‘normal’ prescribing.” 
Significant changes were found in 6 of the 8 drug classes studied at 9 of the 19 hospitals reviewed. The policies were enacted at various times from 2006-2011. Changes in prescribing started immediately and lasted from 12 to 36 months afterward, however. This led to an increase of up to 10% in physicians favoring cheaper generics over more expensive, name-brand drugs – a small, but significant number.  
One thing the study didn’t examine was whether generic drugs were the more medically-sound approach. Privacy laws made it impossible to study that aspect. 
Furthermore, the fact that changes were found in 6 of the 8 drug classes does not prove that physicians made better choices without pharma reps influencing them, though it does appear that was the case.
Study leaders Ian Larkin and George Loewenstein, both economists, suggest that healthcare providers go the route taken by hospitals such as the Mayo Clinic, the Cleveland Clinic, and California’s Kaiser group, which pay their doctors straight salaries. This would create a conflict-free environment where patients don’t have to worry that their doctors making decisions about their health based on money or gifts. 
After all, the “do no harm” snippet from the Hippocratic Oath should include patients’ ability to afford their medicine.
 The JAMA Network
||Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.