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
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2010 Číslo 10
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Pleiotropní účinky statinů na kardiovaskulární systém
- Statiny indukovaná myopatie: Jak na diferenciální diagnostiku?
- Význam hydratace při hojení ran
- DESATORO PRE PRAX: Aktuálne odporúčanie ESPEN pre nutričný manažment u pacientov s COVID-19
Najčítanejšie v tomto čísle
- Epigenetic Epidemiology of Common Complex Disease: Prospects for Prediction, Prevention, and Treatment
- Editors, Publishers, Impact Factors, and Reprint Income
- Systematic Evaluation of Serotypes Causing Invasive Pneumococcal Disease among Children Under Five: The Pneumococcal Global Serotype Project
- The Persisting Burden of Intracerebral Haemorrhage: Can Effective Treatments Be Found?