Could “No See” docs be doing a disservice to patients?

One of the biggest challenges facing any Pharma rep is the increasing number of  doctors who won’t see them. Every week, more and more physicians are restricting, and some even eliminating, their face time with sales reps.

In fact, the number of doctors willing to see reps has declined by about 20% since 2008.  And while some clinicians chose to do this, others have had it thrust upon them by their institutions or employers who are concerned that medical practice may be unduly influenced by pharmaceutical industry representatives.

Although  “no see” advocates argue that removing commercial influence is better for patients, a new study suggests the practice has downsides too.

This should be good news for the Pharma, who has always maintained that the clampdown on reps amounts to overkill and that more than selling, reps  provide information that can benefit patients.

The study, published in the Journal of Clinical Hypertension, divided medical practices into four categories. Based on the degree of sales representative access to clinicians, they were classified as either very low, low, medium, or high.

The clinical decisions, and prescribing behavior of over 72,000 physicians were then statistically analyzed, with regards to the drugs listed below:

The authors found that after the FDA approved Januvia, docs who had little interaction with reps took longer to write prescriptions than docs whose access to reps was not as restricted. Meanwhile, physicians who rarely, if ever, saw reps were slowest to change their prescribing habits after negative news emerged about Avandia and Vytorin .

Specifically, the study found that docs with very low access to reps had the lowest adoption rates for Januvia. They took between 1.6 and 4.6 times longer to start writing prescriptions after the pill was launched than docs who had low, medium or high access to reps. Docs who had very low access to reps were also 4 times slower than those of their counterparts to reduce their use of Avandia, after the Black Box warning was issued in 2007.  There was also “significantly less” change in the prescribing habits of those who had less access to reps in response to controversial and disappointing trial results released in 2008 for Vytorin, than those with fewer restrictions on rep interactions.

The study authors commented, “These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs.”

George Chressanthis, professor of healthcare management and marketing, and acting director for the Center for Healthcare Research and Management at Temple University Fox School of Business, agrees.

The study affirms simple intuition that when physicians have to make decisions involving complex issues with less than complete information available to them, and where the consequence of a wrong decision is significant… unintended consequences are likely to appear. Policies that promote physician ignorance of new medical information resulting from access limits, run counter to protecting patient health.”

Could increasing, rather than decreasing  sales representative access to physicians lead to better clinical decision making and better patient health? Let us know what you think.

More Guidelines on Pharma – Physician relationships

A recent report issued by the Association of American Medical Colleges (AAMC) urges teaching hospitals to establish policies to manage financial relationships between physicians and the pharmaceutical industry so that they do not influence patient care.

The report entitled, In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making is the work of a task force convened by the AAMC in 2009.  It provides guidance on how academic medical centers can identify, evaluate and disclose conflicts of interest in clinical care. In its favor, the report points out that partnerships between academic medical centers and industry are essential to innovation and create powerful collaborations that benefit all patients. However, it warns that the presence of individual or institutional financial interests in these relationships may create perceived or real conflicts of interests in patient care.

Because patients and the health of the public are top priorities for the nation’s medical schools and teaching hospitals, we must uphold the highest standards of professionalism, while maintaining principled relationships with industry to improve patient care,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D.

Although many academic medical centers already have conflict of interest (COI) policies that govern research and corporate relationships, only a small number of these institutions have adopted policies that define and address conflicts of interest in clinical care.

To help academic medical centers develop guidelines, the report suggests that institutions first evaluate their own compensation systems to determine whether they influence physician behavior and conflict with the best interest of patients.

The report also recommends that academic medical centers:

  • Establish mechanisms to identify physician-industry financial relationships and evaluate their potential to bias the clinical decision-making of physicians
  • Consider payments for services, royalties, and ownership when assessing individual related financial interests
  • Set thresholds for physician reporting and institutions’ evaluation of reported interests
  • Make available to their patient communities and the public information on the industry relationships of their physicians, their value, and efforts to mitigate any bias resulting from these relationships
  • Involve patients to help them to determine what information about physician-industry ties is useful and how it should be presented to specific patient groups

As a follow up to the report, the AAMC is developing clinical scenarios that can be used by its members to help define their approach to addressing conflicts of interest in patient care.

SRxA’s Word on Health welcomes these guidelines and is pleased to see that we are now talking about “managing relationships” with the pharmaceutical industry rather than banning them altogether.  Placing the onus on physicians rather than putting punitive prohibitions on pharma is probably a win-win for both sides.