Specifically, the University of Pennsylvania researchers compared psychiatry residents who graduated in 2001, before such policies were instituted, and 2008, when the Association of American Medical Colleges developed consensus principles of conflict of interest policies and one year after the American Medical Student Association began a 'PharmFree' scorecard.
They found that, relative to 2001 graduates in the same residency group, 2008 graduates in programs with 'maximally restrictive' conflict policies prescribed heavily marketed antidepressants significantly less than 2008 graduates in programs with 'minimally restrictive' and 'moderately restrictive' policies, or 4.3 percent and 3.6 percent, respectively.
The results were also consistent for prescribing reformulated and brand-name versions. Again, relative to the 2001 graduates, prescribing rates among the 2008 graduates in programs with maximal restrictions were significantly lower than among 2008 graduates of minimally restrictive programs for both reformulated and brand-name drugs, or 3 percent and 4.5 percent, respectively.
"The study is the first of its kind to show that exposure to COI policies for physicians during residency training – in this case, psychiatrists – is effective in lowering their post-graduation rates of prescriptions for brand medications, including heavily promoted and brand reformulated antidepressants," the researchers say in a statement.
The researchers, whose study appears in Medical Care, analyzed the proportion of prescriptions written by 1,652 psychiatrists, about half of whom graduated in 2001 and the others in 2008. They accounted for 901,805 prescriptions written for antidepressants in 2009 (here is the abstract).
Of the 162 residency programs, 30 percent graduated where there were minimally restrictive conflict policies, 51 percent that had moderately restrictive policies and 19 percent where there were maximally restrictive policies. These were categorized based on conflicts policies that were in place in 2008.
“Contact with the pharmaceutical industry may have important informational benefits for physicians. And, by exposing trainees to industry representatives, we may be helping them prepare to navigate these relationships after graduation,” says Andrew Epstein, research associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, and lead author on the study.
“Nevertheless, while these relationships may be useful in some ways, our study clearly shows that implementation of COI policies have helped shield physicians from the often persuasive aspects of pharmaceutical promotion,” he concluded.
Overall, the 2008 graduates prescribed fewer antidepressants, most likely because they were in the first year of practice and saw fewer patients than 2001 graduates, the researchers notes. But they added, that if the conflict policies work as intended, such prescribing rates should be lower where residency programs have stricter policies (read a study summary here).
Last year, the AMSA noted that more medical schools are adopting policies that warrant good grades. In the most recent annual scorecard last March, 102 medical schools out of a total of 152 – or 67 percent – were given a grade of A or B for their policies governing interactions between drugmakers and faculty and students (back story).