Undue influence

To promote new drugs, pharmaceutical companies often hand out miscellaneous gifts to doctors and medical students, from pens to pizza lunches. But in the last decade, medical schools have begun to crack down on the practice of targeting students. A recent Yale study, published in the medical journal BMJ, suggests that such policies can affect the way those students make prescribing decisions years later.

To see whether physicians choose new, heavily marketed drugs over older but very similar ones, researchers queried a massive database of prescriptions of stimulants, antipsychotics, and antidepressants over a nine-month period in 2008 and 2009. They checked the prescribers’ medical schools and year of graduation, as well as if and when those schools had enacted restrictive gift-giving policies.

For two of the three drug classes studied, physicians whose medical schools had restrictions on industry gifts were significantly less likely to choose new drugs than physicians whose schools allowed the gifts. And experiencing the restrictions for a longer time strengthened that finding—a “dose-response” effect that suggests a causal relationship.

Doctors tend to think pharma gifts don’t sway them, but the evidence suggests otherwise, says Joseph S. Ross ’06MHS, assistant professor of medicine and a senior investigator on the study: “All these very early, sometimes very minimal interactions [are] essentially teaching medical students that it’s okay to take stuff from [business] representatives.”

Keeping Big Pharma away from students may also save money. As long as older and newer drugs in the same class are equally effective, says Ross, the only downstream effect of choosing an older one is a cheaper prescription.