FOLLOW US

This story originally published by ProPublica

by Charles Ornstein ProPublica, May 2, 2017, 11 a.m.

When teaching hospitals put pharmaceutical sales representatives on a shorter leash, their doctors tended to order fewer promoted brand-name drugs and used more generic versions instead, a study published today in the Journal of the American Medical Association shows.

The results were significant compared to doctors who did not work at hospitals that limited sales reps from freely walking their halls or providing meals or gifts, according to research by Ian Larkin, an assistant professor of strategy at the University of California, Los Angeles Anderson School of Management, and colleagues.

Conflicts of interest in medicine have been ubiquitous for many years, but a string of lawsuits, coupled with a crackdown by academic medical centers and public disclosure of industry payments, have brought renewed focus on how these relationships affect prescribing.

For the past 6 1/2 years, ProPublica has tracked payments to doctors, building a tool called Dollars for Docs to let users look up their physicians and sort information in various ways. We've found that some practitioners earn hundreds of thousands of dollars or more each year working with drug and device companies. We've reported how the drugs most aggressively promoted to doctors typically aren't cures or even big medical breakthroughs.

And last year we found an association between payments and higher rates of brand-name prescribing, on average.

Today's issue of JAMA is devoted to conflicts of interest in medicine and includes a viewpoint on what ProPublica has learned by publishing Dollars for Docs and a related tool called Prescriber Checkup, which compares doctors to their peers based on how they prescribe drugs in Medicare.

The teaching hospital study focused on 19 centers in five states that restricted visits by drug reps in one or more ways: limiting access, limiting gifts or punishing those who broke the rules. Larkin's team compared prescriptions by 2,126 doctors at those hospitals with 24,593 peers with similar characteristics who were not subject to the marketing limits. It examined more than 16 million prescriptions in total, using data from CVS Caremark, a large pharmacy benefit manager.

The researchers found significant changes in six of the eight drug classes studied and at nine of the 19 hospitals reviewed. The policies were put in place at different times from 2006 to 2011, but changes in prescribing started immediately and lasted for 12 to 36 months afterward.