Nag, and you shall receive. That is the take-away message from a national survey of nearly 1,900 physicians in which 43 percent in practice more than 30 years acknowledged that they sometimes or often accede to patient demands for brand-name drugs. By comparison, 31 percent of physicians in practice for 10 years or less gave in. Overall, 37 percent of docs cave in to patient nagging.
Among the various specialties, pediatricians, anesthesiologists, cardiologists and general surgeons were significantly less likely to acquiesce relative to internal medicine docs. And those working primarily in solo or two-person practices were significantly more likely to give in than those working in a hospital or medical school - 46 percent % vs 35 percent.
The findings were published this week in a research letter in JAMA Internal Medicine, which is the new name for the Archives of Internal Medicine, by researchers from the Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston (you can look here, but subscription is required).
Two specific forms of industry relationships were associated with significant differences in the percentage of docs who acquiesced to patient demands, they wrote. Thirty-nine percent who received free food or beverages in the workplace honored patient requests sometimes or often compared with 33 percent who did not, they continued.
There were similar "significant differences" among those receiving drug samples - 40 percent versus 31 percent, respectively. And docs who sometimes or often met with industry reps to remain up to date were significantly more likely to comply with patient demands than those who did not - 40 percent versus 34 percent - they found.
What to do? One suggestion is to have a "closed health system, such as the Veterans Health Administration that gives pharmacies primary control over such decisions, but with override capability for rare situations" when it is medically necessary, they write. Hospitals and health systems could consider policies that prevent individual docs from receiving samples and require samples be given to a pharmacy or other appropriate offices.
"Finally, payers such as Medicare or commercial insurers who are interested in increasing the use of generics may consider banning physicians from accepting food and beverages in the workplace," they conclude. "Any potential interventions should be targeted toward older physicians, internists and those in solo or two-person practices."
"These findings are likely the result of the fact that industry gifting of food and beverages coincides with up-to-date meetings with sales reps. Thus, these factors work together to increase the likelihood that physicians will prescribe a brand name and clearly serve a marketing function."
These are provocative ideas, but are deliberate, of course. The findings coincide with increased concerns over the rising costs of healthcare, which in part, can be attributed to expensive medicines. And the proposals may accomplish this. Or may not. But what do you think?
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11 Comments
39 vs 33 40 vs 31 40 vs 34
That's, um, interesting.
Quick poll here: if a drug company promoted data as being "significant" for a product that had 40% efficacy vs 31% for placebo, how many people here would be OK with that? Just curious.
The FDA / EMA could require that all prescriptions be submitted directly from doctors to pharmacies – either electronically or by voice. No more hand-written scripts.
Result will be savings in the human and financial cost of medical errors resulting from bad or misunderstood handwriting.
You can't ply a surgeon with food. Having grown up in a surgical family I can tell you that a surgeon's lunch is the five minutes stuffing a sandwich in his mouth while anesthesia is being induced.
In the context above, "significant" does appear to mean that the differences were "statistically significant". This means that, if the true (unseen) difference between the two groups (food/no food, older/younger, etc.) is ZERO (no difference), then there is less than a 5% chance of seeing differences as large as we did see. Given that the chance of seeing such large differences is very small, we can be reasonably sure that the groups really are different with respect to that outcome.
Whether these differences are "significant" in the sense of "important" or "actionable" is up to the reader.
Those differences would matter to me if I was choosing between two otherwise-equivalent courses of treatment (assuming the difference was whether I survived).
And, fully acknowledging the accuracy of the comments above, they are certainly large enough ("significant" enough) to be actionable for marketing purposes for Pharma. Pharma marketing (maybe all marketing) depends on gaining small advantages in many places.
Surgeons care even less. I attended a focus group of surgeons on prescribing habits one time, watching behind a one way mirror. I can't really say here verbatim what their responses were here, but their criteria boiled down to something akin to the anatomy of the female drug rep.