Having a policy governing pharmaceutical marketing, known as “detailing,” was associated with a 1.67 percentage point decrease in market share for the average promoted drug. Before the policies, the average promoted drug had a market share of 19.3 percent. Those with tougher policies, including an enforcement component, appeared to have more significant results.
“These weren’t terribly onerous restrictions, yet at the same time, they changed prescribing in a way that has really significant cost implications,” Larkin said.
Among the centers that did not have statistically significant changes was Stanford University, one of the earliest adopters of restrictive policies. In 2010, ProPublica reported how Stanford was not enforcing its rules limiting the relationships between doctors and drug companies. It has tightened its oversight since. Stanford doctors prescribed fewer promoted drugs but not enough for the result to be significant.
“We were surprised that some of them [teaching hospitals] were not as significant as we expected them to be,” said Larkin, without singling out particular hospitals. “You can’t just put in a policy. You have to think about it carefully, think about the efforts that really matter and involve the [medical] community.”
