One would like to think that physicians put their patients first. After all, they make a good salary and should not be swayed by some incentives thrown their way, right?
Maybe, in some cases, the answer is no.
A group of researchers at the University of Pennsylvania wanted to find out if psychiatrists who had been educated with restrictive conflict of interest (COI) policies prescribed fewer antidepressants than those psychiatrists who as residents did not receive that training.
Antidepressants, along with their reformulated cousins, are among the most heavily promoted drugs. Prescriptions for antidepressants such as Lexapro and Cymbalta increased nearly 400% over a 20 year period beginning in 1988, according to Andrew J. Epstein, a professor at the Perelman School of Medicine at the University of Pennsylvania.
Incentives could take the form of sponsored trips, speaking engagements, continuing education, and consulting deals for physicians.
And drug companies know incentives work.
Pharmalot, a website that watches the pharmaceutical industry, reports that the University of Pennsylvania researchers looked at psychiatry residents who graduated in 2001 before the restrictive COI policies were implemented. They were compared to 2008 graduates who were educated in conflict of interest policies developed by the American Medical Student Association (AMSA) and its “PharmFree Campaign” scorecard in 2007.
Their findings were not surprising. The 2008 graduates prescribed reformulated and brand-name drugs only 3% of the time, in comparison with a higher 4.5% rate for 2001 graduates. In addition, the 2008 graduates who were subjected to the most restrictive conflict of interest training prescribed fewer antidepressants when compared to graduates from the same year who were educated with minimally or moderately restrictive conflict of interest policies. All of the 2008 grads prescribed fewer drugs than their 2001 counterparts.
Penn Medicine implemented restrictive policies in 2006 that address the interactions between drug reps and physicians. The Association of American Medical Colleges also developed conflict of interest policy guidelines for physicians in training.
In 2011-2012 it graded medical schools on their COI policies. Getting an “A” grade were 49% of facilities, 10% got a “B” 9% received a “C” grade and 6% a “D” grade.
The American Medical Student Association (AMSA) says more and more medical schools are implementing conflict of interest policies. Last March 102 out of 152 medical schools, or 67%, had received an “A” or “B” for their policies that restrict interaction between drug makers and doctors in training.
In 2008, Harvard psychiatrist Joseph Biederman was caught underreporting the funding he received from the pharmaceutical industry to the tune of $1.6 million in payments. The New York Times reported that Dr. Biederman’s work helped fuel a 40-fold increase in the diagnosis of pediatric bipolar disorder, which was accompanied by prescriptions for powerful antipsychotic medications such as Risperidone.
The facility where Dr. Biederman conducted testing on ADHA and bipolar disorder was named the Johnson & Johnson Center, so named to be transparent about its funding. It just so happens that Risperidone is made by Janssen, a division of J&J.
These conflicts are among the reasons the Physician Payment Sunshine Act was developed to hold down the costs of excessive prescribing. It is scheduled to become part of healthcare reform.