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Association of marketing interactions with medical trainees' knowledge about evidence-based prescribing: results from a national survey.

JAMA internal medicine (2014-06-10)
Kirsten E Austad, Jerry Avorn, Jessica M Franklin, Eric G Campbell, Aaron S Kesselheim
ABSTRACT

In recent years, numerous US medical schools and academic medical centers have enacted policies preventing pharmaceutical sales representatives from interacting directly with students. Little is known about how pharmaceutical sales representatives affect trainees' knowledge about pharmaceutical prescribing. To determine whether there is an association between medical trainees' interactions with pharmaceutical promotion and their preferences in medication use. We surveyed a nationally representative sample of first- and fourth-year medical students and third-year residents by randomly selecting at least 14 trainees at each level per school. All trainees were asked how often they used different educational resources to learn about prescription drugs. Among fourth-year students and residents, we posed a series of multiple choice knowledge questions asking about the appropriate initial therapy for clinical scenarios involving patients with diabetes, hyperlipidemia, hypertension, and difficulty sleeping. Evidence-based answers followed widely used clinical guidelines, while marketed-drug answers favored brand-name drugs over generic alternatives. We used survey answers to build an industry relations index assessing each trainee's level of acceptance of pharmaceutical promotion; we used proportional odds logistic regression models to estimate the association between the index and responses to the knowledge questions. The 1601 student (49.0% response rate) and 735 resident (42.9% response rate) respondents reported common use of unfiltered sources of drug information such as Google (74.2%-88.9%) and Wikipedia (45.2%-84.5%). We found that 48% to 90% of fourth-year students and residents accurately identified evidence-based prescribing choices. A 10-point higher industry relations index was associated with 15% lower odds of selecting an evidence-based prescribing choice (odds ratio [OR], 0.85; 95% CI, 0.79-0.92) (P < .001). There was also a significant association between the industry relations index and greater odds of choosing to prescribe brand-name drugs (OR, 1.08; 95% CI, 1.00-1.16) (P = .04). Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes.

MATERIALS
Product Number
Brand
Product Description

Supelco
Amlodipine besylate, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Simvastatin, ≥97% (HPLC), solid
Supelco
Simvastatin, Pharmaceutical Secondary Standard; Certified Reference Material
Supelco
Lovastatin, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Glybenclamide, ≥99% (HPLC)
Sigma-Aldrich
Mevinolin from Aspergillus sp., ≥98% (HPLC)
Supelco
Glyburide (Glibenclamide), Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Amlodipine besylate, ≥98% (HPLC)
Amlodipine besylate, European Pharmacopoeia (EP) Reference Standard
Supelco
Simvastatin, analytical standard
USP
Amlodipine besylate, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Glyburide, meets USP testing specifications
USP
Lovastatin, United States Pharmacopeia (USP) Reference Standard
Amlodipine for peak identification, European Pharmacopoeia (EP) Reference Standard
USP
Simvastatin, United States Pharmacopeia (USP) Reference Standard
Lovastatin, European Pharmacopoeia (EP) Reference Standard
Glybenclamide, European Pharmacopoeia (EP) Reference Standard
Glibenclamide for peak identification, European Pharmacopoeia (EP) Reference Standard
Simvastatin, European Pharmacopoeia (EP) Reference Standard