Guidelines for COIs, such as receipt of gifts, free meals and free drug samples by physicians and trainees were developed by the Association of American Medical Colleges in 2008. The worry at that time was that scientists may be influenced in the way they interpret their research or physicians may be influenced to prescribe brand-name rather than generic drugs due to their relationships with the pharmaceutical industry rather than based on objectivity or what is best for the patient. The COI policies were thus deemed necessary in order to preserve the integrity of scientists and physicians and so that relationships with the pharmaceutical industry ‘do not undermine the integrity of science or the practice of medicine’. The University of Pennsylvania implemented its own COI policies in 2006.

Antidepressants have been among the most heavily marketed drug classes in recent years and data show that antidepressant use increased nearly 400% from 1988 to 2008.

The study, which is the first of its kind to provide evidence of the effects of COI policies on prescribing behaviour, analyzed IMS Health data for physician-level national administrative prescribing in 2009 for 1,652 psychiatrists from 162 residency programmes. The authors, Epstein et al., investigated differences in antidepressant prescribing in psychiatrists who graduated before (2001) or after (2008) COI policy adoption across residency programme groups with maximally, moderately and minimally restrictive COI policies.

The results showed that rates of prescribing heavily promoted, brand reformulated, and brand-name antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness. The difference between pre-COI and post-COI in prescribing of heavily promoted drugs was more pronounced in graduates from maximally restrictive programmes compared to both minimally restrictive programmes (-4.3%, 95% CI: -7.0, -1.6) and moderately restrictive programmes (-3.6%, 95% CI: 6.2, -1.1). The difference between pre-COI and post-COI in prescribing reformulations was also larger for maximally restrictive programmes compared to minimally restrictive programmes (-3.0%; 95% CI: -5.3, -0.7).

Epstein et al. concluded that the ‘results suggest that COI policies can help inoculate physicians against persuasive aspects of pharmaceutical promotion’. They also suggested that further research should be carried out in order to ‘assess whether these policies affect other drug classes and physician specialties similarly’.

Conflict of interest
The authors of the study did not declare any conflicts of interest.

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Reference

1.  Epstein AJ, Busch SH, Busch AB, Asch DA, Barry CL. Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing? Med Care. 2013 Feb;51(2):199-203.

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