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Science Careers Blog

January 18, 2013

Teaching Doctors (and Researchers?) to be More Skeptical

A study from the Perelman School of Medicine at the University of Pennsylvania reveals that psychiatrists who were exposed to conflict of interest (COI) policies during their residency are less likely than peers who lack similar training to prescribe brand-name antidepressants, which are heavily promoted to psychiatrists and tend to be more expensive.

"Our study clearly shows that implementation of COI policies have helped shield physicians from the often persuasive aspects of pharmaceutical promotion," first author Andrew Epstein stated in the press release. The results will be published in the February issue of the journal Medical Care, and are already available online (though you'll need to have a subscription or buy the article if you want to read more than the abstract). 

If the results are correct, the significance may extend far beyond the very important issue of COI in medical training.

"Our study focuses on antidepressants because they have been among the most heavily marketed drug classes," Epstein said. "Data show that antidepressant use increased nearly 400 percent from 1988 to 2008. The goal for this study was to determine whether exposure to COI policies during residency would influence psychiatrists' antidepressant prescribing patterns after graduation."

The press release continues:
In recent years, as a result of the dramatic increase in prescription drug use, relationships between pharmaceutical representatives and physicians have come under extensive scrutiny both within the medical profession and by policy makers. Penn Medicine in 2006 implemented policies placing restrictions on physician interactions with pharmaceutical representatives. In 2008, the Association of American Medical Colleges developed COI policy guidelines for gifts, free meals, and medication samples provided by pharmaceutical representatives to physicians and trainees. The concern was that these interactions could influence clinicians to prescribe brand medications even if they were more expensive or less suitable for patients than generic alternatives.
Epstein and coauthors studied two cohorts, one that graduated from their residency program in 2001, before COI training was widespread, and another that graduated in 2008, after widespread COI training had been put in place. They studied prescriptions written by both groups in 2009. They found that the latter cohort was less likely to prescribe the widely promoted antidepressants than the former--and that those who graduated from residency programs with the most restrictive COI policies were the least likely to prescribe those medications.

Some skepticism of the results would seem to be warranted, since the two groups studied were separated by 7 years; there could be more difference between the two groups than COI policy exposure. But if the result is valid--if it stands up to further scrutiny--its significance may go well beyond the influence of pharmaceutical company marketing on medical trainees--though that is indeed a very important issue.

If it proves valid, the result shows that even among these very smart people, skepticism can be acquired via casual exposure. Could the same thing work for scientists in training? Could it be that grad students trained in laboratories where they are encouraged to be skeptical of received scientific wisdom are more likely to entertain alternative points of view? Could it be that mentors/advisers could produce more open-minded proteges simply by suggesting that the conventional wisdom is sometimes wrong? Could scientists who are made conscious of the conformist pressures endemic in the scientific workplace be more likely than their peers to question the scientific status quo? 

My thanks to Elisabeth Pain, Contributing Editor for Europe, for, introducing me this idea.

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