Medical school restrictions linked to doctors' prescribing habits

Feb. 1, 2013, 11:43 a.m.

Medical schools who forbid their doctors from accepting gifts from the pharmaceutical industry graduate students who are less inclined to prescribe newly-marketed drugs, says a new study. (Rennett Stowe/Flickr Creative Commons)

It's a pretty simple formula: When drug companies give free things to doctors, those doctors usually feel obligated to return the favor.

So says Eric Campbell, a professor of medicine at Harvard Medical School. Drug companies will often give gifts to doctors – meals or samples of their product, for example – in order to incentivize them to prescribe its brand to their patients.

Campbell has at least a couple of problems with that.

"We know that by and large, drug companies market drugs that are not the best," he explained, suggesting that a quality drug won't need much creative marketing. "If you have a drug that works really, really well – better than anything else – people will use it."

He also pointed out an interesting phenomenon: If you ask doctors whether accepting gifts from the pharmaceutical industry affects their practice, they'll always say no. But, said Campbell, if you ask if it affects other doctors' practices, they'll usually say yes.

"For doctors to ignore that and say that they are the one group in the history of the world that is not susceptible to the effects of gifts because they went to medical school is ludicrous," he said.

The Harvard professor was the lead author on a study released earlier this year that looked at how often doctors prescribe expensive brand-name medications when cheaper, generic versions are readily available. Now, a new study appearing in the British Medical Journal examined whether medical school policies that prohibit the doctors who teach there from accepting gifts affects their students' future behavior.

In short: It seems like it.

Researchers looked at whether attending a medical school with a gift-restriction policy affected students' prescribing of three newly-marketed drugs after they graduated. For two of the three drugs, the restriction was linked to fewer prescriptions by graduates. (No significant effect was seen on the third drug.)

Campbell said medical schools and teaching hospitals have "clamped down on gifts from the industry" in recent years, meaning that a decreasing number of doctors who teach at those places are allowed to accept gifts.

Among doctors in private practices, however, no such restrictions exist, so gift acceptances have "declined very little."

What does that mean for the health care industry as a whole? No one knows for sure, said Campbell. But there's at least one probable effect.

"If you're a medical school or teaching hospital, and you allow your doctors to take gifts from drug companies and go to fancy meals, what you're telling your students is that culture of payola is OK," he said.

The study looked at 14 medical schools in the United States. Campbell noted that since there are 125 schools in the U.S., it's hard to say how much the results from the BMJ study can be "generalized."

Photo by Rennett Stowe via Flickr Creative Commons.

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