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Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review


Background:
Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.

Methods and Findings:
We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.

Conclusions:
With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.

: Please see later in the article for the Editors' Summary


Vyšlo v časopise: Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review. PLoS Med 7(10): e32767. doi:10.1371/journal.pmed.1000352
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000352

Souhrn

Background:
Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing.

Methods and Findings:
We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review.

Conclusions:
With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.

: Please see later in the article for the Editors' Summary


Zdroje

1. GagnonMA

LexchinJ

2008 The cost of pushing pills: a new estimate of pharmaceutical promotion expenditures in the United States. PLoS Med 5 e1 doi:10.1371/journal.pmed.0050001

2. BrasPL

RicordeauP

RoussilleB

SaintoyantV

L'information des médecins généralistes sur le médicament. Report No RM 2007-136 P. Inspection générale des affaires sociales. September 2007. Available: http://lesrapports.ladocumentationfrancaise.fr/BRP/074000703/0000.pdf. Accessed 10 July 2010

3. GaraiP

1964 Advertising and promotion of drugs.

TalalayP

Drugs in our society Baltimore John Hopkins Press

4. Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Healthcare Professionals. Available: http://www.phrma.org/code_on_interactions_with_healthcare_professionals. Accessed 8 July 2010

5. ProsserH

WalleyT

2003 Understanding why GPs see pharmaceutical representatives: a qualitative interview study. Br J Gen Pract 53 305 311

6. ChimonasS

BrennanTA

RothmanDJ

2007 Physicians and drug representatives: exploring the dynamics of the relationship. J Gen Intern Med 22 184 190

7. FischerMA

KeoughME

BarilJL

SaccoccioL

MazorKM

2009 Prescribers and pharmaceutical representatives: why are we still meeting? J Gen Intern Med 24 795 801

8. SteinmanMA

ShlipakMG

McPheeSJ

2001 Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. Am J Med 110 551 557

9. RutledgeP

CrookesD

McKinstryB

MaxwellSR

2003 Do doctors rely on pharmaceutical industry funding to attend conferences and do they perceive that this creates a bias in their drug selection? Results from a questionnaire survey. Pharmacoepidemiol Drug Saf 12 663 667

10. MorganMA

DanaJ

LoewensteinG

ZinbergS

SchulkinJ

2006 Interactions of doctors with the pharmaceutical industry. J Med Ethics 32 559 563

11. BlumenthalD

2004 Doctors and drug companies. N Engl J Med 351 1885 1890

12. RothmanDJ

McDonaldWJ

BerkowitzCD

ChimonasSC

DeAngelisCD

2009 Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA 301 1367 1372

13. MansfieldPR

LexchinJ

WenLS

GrandoriL

McCoyCP

2006 Educating health professionals about drug and device promotion: advocates' recommendations. PLoS Med 3 e451 doi:10.1371/journal.pmed.0030451

14. OthmanN

VitryA

RougheadEE

2009 Quality of pharmaceutical advertisements in medical journals: a systematic review. PLoS One 4 e6350 doi:10.1371/journal.pone.0006350

15. MontgomeryBD

MansfieldPR

SpurlingGK

WardAM

2008 Do advertisements for antihypertensive drugs in Australia promote quality prescribing? A cross-sectional study. BMC Public Health 8 167

16. ZieglerMG

LewP

SingerBC

1995 The accuracy of drug information from pharmaceutical sales representatives. JAMA 273 1296 1298

17. HemminkiE

1977 Content analysis of drug-detailing by pharmaceutical representatives. Med Educ 11 210 215

18. WazanaA

2000 Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 283 373 380

19. ZipkinDA

SteinmanMA

2005 Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med 20 777 786

20. ManchandaP

HonkaE

2005 The effects and role of direct-to-physician marketing in the pharmaceutical industry: an integrative review. Yale J Health Policy Law Ethics 5 785 822

21. HigginsJ

2008 Assessing risk of bias in included studies.

AltmanDG

HigginsJPT

GS

Cochrane handbook for systematic reviews of interventions Version 501 The Cochrane Collaboration Chichester, UK Wiley-Blackwell

22. WellsG

SheaB

O'ConnellD

PetersonJ

WelchV

2005 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 12 September 2010

23. DeeksJJ

DinnesJ

D'AmicoR

SowdenAJ

SakarovitchC

2003 Evaluating non-randomised intervention studies. Health Technol Assess 7 iii x, 1–173

24. StroupDF

BerlinJA

MortonSC

OlkinI

WilliamsonGD

2000 Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283 2008 2012

25. HemminkiE

KarttunenT

HoviSL

KarroH

2004 The drug industry and medical practice–the case of menopausal hormone therapy in Estonia. Soc Sci Med 58 89 97

26. ClearyJD

1992 Impact of pharmaceutical sales representatives on physician antibiotic prescribing. J Pharm Technol 8 27 29

27. SchwartzTL

KuhlesDJ2nd

WadeM

MasandPS

2001 Newly admitted psychiatric patient prescriptions and pharmaceutical sales visits. Ann Clin Psychiatry 13 159 162

28. OrlowskiJP

WateskaL

1992 The effects of pharmaceutical firm enticements on physician prescribing patterns. There's no such thing as a free lunch. Chest 102 270 273

29. HendersonJ

MillerG

PanY

BrittH

2008 The effect of advertising in clinical software on general practitioners' prescribing behaviour. Med J Aust 188 15 20

30. GrevingJP

DenigP

van der VeenWJ

BeltmanFW

SturkenboomMC

2006 Determinants for the adoption of angiotensin II receptor blockers by general practitioners. Soc Sci Med 63 2890 2898

31. KreyenbuhlJ

MarcusSC

WestJC

WilkJ

OlfsonM

2007 Adding or switching antipsychotic medications in treatment-refractory schizophrenia. Psychiatr Serv 58 983 990

32. CanliH

SaatciE

BozdemirN

AkpinarE

KirogluM

2006 The antibiotic prescribing behaviourof physicians for acute tonsillopharyngitis in primary care. Ethiop Med J 44 139 143

33. PeayMY

PeayER

1988 The role of commercial sources in the adoption of a new drug. Soc Sci Med 26 1183 1189

34. CharbitO

2003 [Influence de la publicité pharmaceutique sur la prescription.] Influence of pharmaceutical advertising on prescription [MD dissertation] Toulouse University Paul Sabatier Toulouse III

35. FreemantleN

JohnsonR

DennisJ

KennedyA

MarchmentM

2000 Sleeping with the enemy? A randomized controlled trial of a collaborative health authority/industry intervention to influence prescribing practice. Br J Clin Pharmacol 49 174 179

36. DolovichL

LevineM

TarajosR

DukuE

1999 Promoting optimal antibiotic therapy for otitis media using commercially sponsored evidence-based detailing: A prospective controlled trial. Drug Information Journal 33 1067 1077

37. AndersenM

KragstrupJ

SondergaardJ

2006 How conducting a clinical trial affects physicians' guideline adherence and drug preferences. JAMA 295 2759 2764

38. ChrenMM

LandefeldCS

1994 Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary. JAMA 271 684 689

39. SpingarnRW

BerlinJA

StromBL

1996 When pharmaceutical manufacturers' employees present grand rounds, what do residents remember? Acad Med 71 86 88

40. VenkataramanS

StremerschS

2007 The debate on influencing doctors' decisions: are drug characteristics the missing link? Manage Sci 53 1688 1701

41. WindmeijerF

de LaatE

DouvenR

MotE

2006 Pharmaceutical promotion and GP prescription behaviour. Health Econ 15 5 18

42. ChintaguntaP

DesirajuR

2005 Strategic detailing and pricing behaviour in international markets. Marketing Science 24 67 80

43. NarayananS

ManchandaP

ChintaguntaPK

2005 Temporal differences in the role of marketing communication in new product categories. J Marketing Res 42 278 290

44. DonohueJ

BerndtE

2004 Effects of direct-to-consumer advertising on medication choice: the case of anti-depressants. J Public Policy Mark 23 115 127

45. MizikN

JacobsonR

2004 Are physicians “easy marks”? quantifying the effects of detailing and sampling on new prescriptions. Manage Sci 50 1704 1715

46. ManchandaP

ChintaguntaP

2004 Responsiveness of physician prescription behaviour to salesforce effort: an individual level analysis. Market Lett 15 129 145

47. ManchandaP

RossiP

ChintaguntaP

2004 Response modeling with nonrandom marketing-mix variables. J Marketing Res 41 467 478

48. BerndtE

PindyckR

AzoulayP

2003 Consumption externalities and diffusion in pharmaceutical markets: antiulcer drugs. The J Ind Econ L1 243 270

49. AzoulayP

2002 Do pharmaceutical sales respond to scientific evidence? J Econ Manage Str 11 551 594

50. RizzoJ

1999 Advertising and competition in the ethical pharmaceutical industry: the case of antihypertensive drugs. J Law Econ 42 89 116

51. HurwitzM

CavesR

1988 Persuasion or information? promotion and the shares of brand name and generic pharmaceuticals. J Law Econ 31 299 320

52. MackowiakJI

GagnonJP

1985 Effects of promotion on pharmaceutical demand. Soc Sci Med 20 1191 1197

53. LefflerK

1981 Persuasion or information? the economics of prescription drug advertising. J Law Econ 24 45 74

54. TelserL

BestW

EganJ

HiginbothamH

1975 The theory of supply with applications to the ethical pharmaceutical industry. J Law Econ 18 449 478

55. SpurlingG

MansfieldP

2007 General practitioners and pharmaceutical sales representatives: quality improvement research. Qual Saf Health Care 16 266 270

56. StaffordRS

FurbergCD

FinkelsteinSN

CockburnIM

AlehegnT

2004 Impact of clinical trial results on national trends in alpha-blocker prescribing, 1996–2002. JAMA 291 54 62

57. AuvrayL

HensgenF

SermetC

2003 La diffusion de l'innovation pharmaceutique en médicine libérale: revue de la littérature et premiers résultants français. Bulletin d'information en économie de la santé 73

58. SoumeraiSB

AvornJ

GortmakerS

HawleyS

1987 Effect of government and commercial warnings on reducing prescription misuse: the case of propoxyphene. Am J Public Health 77 1518 1523

59. KazmierczakR

ColeyKC

1997 Impact of Dear Doctor letters on prescribing: evaluation of the use of tramadol HCl. Formulary 32 977 978

60. BowmanMA

PearleDL

1988 Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Contin Educ Health Prof 8 13 20

61. de BakkerDH

CoffieDS

HeerdinkER

van DijkL

GroenewegenPP

2007 Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis. BMC Health Serv Res 7 132

62. SteinmanMA

HarperGM

ChrenMM

LandefeldCS

BeroLA

2007 Characteristics and impact of drug detailing for gabapentin. PLoS Med 4 e134 doi:10.1371/journal.pmed.0040134

63. VerdouxH

CougnardA

GrolleauS

BegaudB

2005 Impact of visits from pharmaceutical company representatives on antipsychotic prescription in primary care. Schizophr Res 77 107 109

64. MuijrersPE

GrolRP

SijbrandijJ

JanknegtR

KnottnerusJA

2005 Differences in prescribing between GPs: impact of the cooperation with pharmacists and impact of visits from pharmaceutical industry representatives. Fam Pract 22 624 630

65. HuangFY

WeissDS

FenimorePG

FlemingAM

HallerE

2005 The association of pharmaceutical company promotional spending with resident physician prescribing behavior. Acad Psychiatry 29 500 501

66. WatkinsC

HarveyI

CarthyP

MooreL

RobinsonE

2003 Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care 12 29 34

67. ProsserH

WalleyT

2003 New drug uptake: qualitative comparison of high and low prescribing GPs' attitudes and approach. Fam Pract 20 583 591

68. CaamanoF

FigueirasA

Gestal-OteroJJ

2002 Influence of commercial information on prescription quantity in primary care. Eur J Public Health 12 187 191

69. GonulF

CarterF

PetrovaE

SrinivasanK

2001 Promotion of prescription drugs and its impact on physicians' choice behaviour. J Marketing 65 79 90

70. JonesM

GreenfieldS

BradleyC

1999 A survey of the advertising of nine new drugs in the general practice literature. J Clin Pharm Ther 24 451 460

71. CaudillTS

JohnsonMS

RichEC

McKinneyWP

1996 Physicians, pharmaceutical sales representatives, and the cost of prescribing. Arch Fam Med 5 201 206

72. BeringsD

BlondeelL

HabrakenH

1994 The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice. Eur J Clin Pharmacol 46 501 505

73. LurieN

RichEC

SimpsonDE

MeyerJ

SchiedermayerDL

1990 Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff. J Gen Intern Med 5 240 243

74. HaayerF

1982 Rational prescribing and sources of information. Soc Sci Med 16 2017 2023

75. WaltonH

1980 Ad recognition and prescribing by physicians. J Advertising Res 20 39 48

76. DajdaR

1978 Drug advertising and prescribing. J R Coll Gen Pract 28 538 541

77. BeckerMH

StolleyPD

LasagnaL

McEvillaJD

SloaneLM

1972 Differential education concerning therapeutics and resultant physician prescribing patterns. J Med Educ 47 118 127

78. ChingA

IshiharaM

2007 The effects of detailing on prescribing decisions under two-sided learning. Available: http://mpra.ub.uni-muenchen.de/4935/. Accessed 21 October 2009. Toronto: Rotman School of Management, University of Toronto

79. RosenthalM

BerndtE

DonohueJ

EpsteinA

FrankR

2003 Demand effects of recent changes in prescription drug promotion Cambridge Harvard School of Public Health

80. Health Care Communications 1989 The effect of journal advertising on market shares of new prescriptions New York Health Care Communications Inc.

81. BlondeelL

CannoodtL

De MeyereM

ProesmansH

PharmD

1987 Prescription behaviour of 358 Flemish general practitioners. In: Proceedings of the International Society of General Medicine Conference. Prague

82. MansfieldP

2000 Year of graduation, level of “scepticism” and attendance at sponsored meetings are significant predictors of General Practioners' beliefs about the appropriateness of drugs Adelaide Medical Lobby for Appropriate Marketing Inc Available: http://www.healthyskepticism.org/global/news/int/hsin2010-05. Accessed 12 September 2010

83. ChingA

IshiharaM

2010 The effects of detailing on prescribing decisions under quality uncertainty. Quant Mark Econ 8 123 165

84. LidstoneJ

CollierT

1987 Marketing planning for the pharmaceutical industry Aldershot (UK) Gower

85. LexchinJ

1995 Deception by design: pharmaceutical promotion in the third world Penang Consumers International

86. VancelikS

BeyhunNE

AcemogluH

CalikogluO

2007 Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey. BMC Public Health 7 122

87. BrodyH

2005 The company we keep: why physicians should refuse to see pharmaceutical representatives. Ann Fam Med 3 82 85

88. American Medical Student's Association. Available: http://www.amsa.org/. Accessed 7 October 2009

89. No Free Lunch. Available: http://www.nofreelunch.org/aboutus. Accessed 7 October 2009

90. JohnstonSC

HauserSL

2007 Marketing and drug costs: who is laughing and crying? Ann Neurol 61 11A 12A

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