A recent study examines the unintended consequences for patients when doctors restrict their access to pharmaceutical reps.

As academia and the media continue to vilify the pharmaceutical industry and the “dangers” of drug reps, more and more private physicians are enacting restrictive policies on pharmaceutical representative access. In fact, since 2008, the number of doctors willing to see pharma reps has declined about 20%. In 2010, about 11% of American physicians had “severe” or “no-see” restrictions on pharma rep access, while 34% had “some” access restricted. It is unlikely that any of the institutions or physician practices initiating these policies have considered the unintended consequences of restricting pharma rep access to physicians.

Fortunately, a recent study examined this very question. In “Can Access Limits on Sales Representatives to Physicians Affect Clinical Prescription Decisions?” published recently in The Journal of the American Society of Hypertension, the authors attempted to analyze the importance of the link between physicians and pharmaceutical representatives by examining three prescribing practices:
1. Adoption of a new diabetes medicine (Januvia) in 2006
2. Decreases in prescribing Avandia after the FDA placed a box warning on it in 2007
3. Decreases in prescribing Vytorin when a 2008 study showed no benefit over simvastatin alone

IMS data was used to analyze physician prescribing, and a database of pharma representative interactions with 300,000 physicians was used to determine access. They categorized physicians into very low access, low access, medium access and high access. Their results showed that physicians with very low access had the lowest adoption of the new diabetes medicine, taking 1.4 times longer to prescribe than the low access physicians, and 4.6 times longer to prescribe than the medium access physicians. In response to the Avandia box warning, doctors with very low access were 4.0 times slower to reduce their use of Avandia than those with low access. Similar numbers were seen with prescriptions of Vytorin after negative data was released. In other words, doctors who restricted access to pharma reps were about four times less likely to respond to either positive (new drug available) or negative (safety issues, lack of efficacy) information than docs who allowed at least some access to pharmaceutical representatives.

Clearly the results demonstrate that pharma reps bring value to physicians beyond simply “selling” their products. If we looked at clinical outcomes—such as glucose control in diabetics, LDL levels in patients with cardiovascular risk, and systolic blood pressure in hypertensives—I would bet that physicians who interact with reps would be more likely to have their patients at the appropriate targets, though probably with an increase of branded product utilization.

It is unclear when this happened, but it seems like academicians, policy makers, and the media have forgotten that pharmaceuticals help patients, and in many cases are life-saving. Unfortunately, the glitzy promotion of blockbuster pills has left the impression that pharmaceutical marketing is focused solely on profits, not patients. To reverse this trend, stakeholders must be made aware of the study regarding the risks that policies that limit access to information can cause, and the industry must commit itself to ensuring their message is about providing value to patients and healthcare professionals. In order to accomplish this, perhaps it’s time to get rid of the sales aids and focus on providing new information, especially regarding disease state, even if your product is not involved.

What is apparent from the JASH study is that the industry does bring value to physicians in the form of new information, and when physicians do not have access to this information, bad things can happen. A renewed focus by the pharma industry on providing such information to physicians may shift physician opinion and reverse the trend of these dangerous restrictive policies.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at www.drmintz.com.


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