Pharmaceutical promotion to physicians and First Amendment rights.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
New England Journal of Medicine (Impact Factor: 54.42). 05/2008; 358(16):1727-32. DOI: 10.1056/NEJMsb0708920
Source: PubMed
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    ABSTRACT: The treatment of pediatric depression is controversial because it includes substantial prescribing of drugs for uses that have not been approved by the Food and Drug Administration ("off label") and are not evidence based. Some academic medical centers (AMCs) restrict "detailing" by pharmaceutical sales representatives, or the promoting of drugs directly to physicians via sales calls, to reduce the effect of such marketing on physician prescribing. With data from thirty-one geographically diverse AMCs and their affiliated hospitals, we used a difference-in-differences model to estimate the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006-June 2009. We found that after the introduction of such policies, prescriptions for off-label use of promoted drugs fell by 11 percent, consistent with the ongoing presence of off-label marketing to physicians. Prescriptions for on-label use of promoted drugs fell by 34 percent after the adoption of the policies. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for off-label use of nonpromoted drugs rose by 35 percent. These results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing.
    Health Affairs 06/2014; 33(6):1014-23. DOI:10.1377/hlthaff.2013.0939 · 4.32 Impact Factor
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    ABSTRACT: agents administered during hospi- talization at a tertiary care acade- mic medical center. The retrospec- tive analysis was conducted over 1 year. A total of 416 allergies were reported among 300 patients; more than 1 allergy was reported by more than one-fourth of study patients (82/300 (27.3%)). Only 36.3% (151/416) of allergies reported were accompanied by a reaction description (95% confi- dence interval (CI), 31.7% to