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Healthy Skepticism Library item: 2312

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Chren MM, Landefeld CS.
Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary.
JAMA 1994 Mar 2; 271:(9):684-9
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed


Abstract:

OBJECTIVE—It is controversial whether physicians’ interactions with drug companies affect their behavior. To test the null hypothesis, that such interactions are not associated with physician behavior, we studied one behavior: requesting that a drug be added to a hospital formulary.

DESIGN—Nested case-control study.

SETTING—University hospital.

PARTICIPANTS—Full-time attending physicians. Case physicians were all 40 physicians who requested a formulary addition from January 1989 through October 1990. Control physicians were 80 randomly selected physicians who had not made requests.

MAIN EXPOSURE MEASURE—Physician interactions with drug companies, as determined by survey of physicians (response rate, 88% [105/120]).

RESULTS—Physicians who had requested that drugs be added to the formulary interacted with drug companies more often than other physicians; for example, they were more likely to have accepted money from companies to attend or speak at educational symposia or to perform research (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.0 to 13.2). Furthermore, physicians were more likely than other physicians to have requested that drugs manufactured by specific companies be added to the formulary if they had met with pharmaceutical representatives from those companies (OR, 13.2; 95% CI, 4.8 to 36.3) or had accepted money from those companies (OR, 19.2; 95% CI, 2.3 to 156.9). These associations were consistent in multivariable analyses controlling for potentially confounding factors. Moreover, physicians were more likely to have requested formulary additions made by the companies whose pharmaceutical representatives they had met (OR, 4.9; 95% CI, 3.2 to 7.4) or from whom they had accepted money (OR, 1.7; 95% CI, 1.0 to 2.7) than they were to have requested drugs made by other companies.

CONCLUSION—Requests by physicians that drugs be added to a hospital formulary were strongly and specifically associated with the physicians’ interactions with the companies manufacturing the drugs.

Keywords:
MeSH Terms: Biomedical Research Case-Control Studies Choice Behavior Data Collection Drug Industry* Formularies, Hospital* Hospital Bed Capacity, 500 and over Hospitals, University Institutional Practice/economics Interprofessional Relations* Medical Staff, Hospital/statistics & numerical data* Ohio Publishing Research Support/economics Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963