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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.

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.

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.