The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?

Decision-making by physicians on patients’ treatment has come under increased public scrutiny. In fact, there is a fair amount of debate on the effects of marketing actions of pharmaceutical firms toward physicians and their impact on physician prescription behavior. While some scholars find a strong and positive influence of marketing actions, some find only moderate effects, and others even find negative effects. Debate is also mounting on the role of other influencers (such as patient requests) in physician decision-making, both on prescriptions and sample-dispensing. The authors argue that one factor that may tip the balance in this debate is the role of drug characteristics, such as a drug’s effectiveness and a drug’s side effects. Using a unique data set, they show that marketing efforts – operationalized as detailing and symposium meetings of firms to physicians – and patient requests do affect physician decision-making differentially across brands. Moreover they find that the responsiveness of physicians’ decision-making to marketing efforts and patient requests depends upon the drug’s effectiveness and side effects. The paper presents clear guidelines for public policy and managerial practice and envisions that the study of the role of drug characteristics – such as effectiveness and side effects – may lead to valuable insights in this surging public debate.public policy;side effects;sampling;Physician decision-making;drug effectiveness;drug prescription;marketing efforts;patient requests;pharmaceuticals;sample-dispensing

Problems associated with the diagnosis and the prescribing of anti-psychotic medication in children and adolescents for psychiatric conditions, by non-psychiatric specialists

Aim: The objective of this study is to assess the accuracy of the diagnosis and appropriateness of antipsychotic medication prescribed to children and adolescents referred to child guidance clinic, and how many of these remained on the said medication after consultant psychiatrist and multidisciplinary team review. Method: A retrospective case notes review of all the children referred to a child guidance clinic in the period June 2005 to July 2006 were analysed, looking specifically at the referral tickets, the treatment on first interview with a member of the multidisciplinary team at the clinic, the working diagnosis of the team, and the management plan after at least six months of follow up at child guidance clinic. There was very good interrater reliability between the two observers looking at the case notes. Results: One hundred and fifty four (63.1%) out of a total of 244 children who were referred carried an admission diagnosis, which differed from the working diagnosis after 6 months. A total of 66 children (27%) were started on various types of psychiatric treatment prior to referral. Thirty (45.5%) of these were prescribed sulpiride, an atypical neuroleptic. Following review by the multi-disciplinary team, the medication of 25 (83.3%) of these children was terminated or altered. Conclusion: This report highlights the need of consultation liaison with general practitioners and also Continued Medical Education courses for general practice management in child and adolescent psychiatry. It is advisable that non psychiatric specialists limit the use of antipsychotic medication to children and adolescents without expert advice and in addition, should refer all such children with urgency.peer-reviewe

Hospital specialists' private practice and its impact on the number of NHS patients treated and on the delay for elective surgery.

This paper analyses UK NHS waiting times and waiting lists for elective surgery looking at the hospital specialists' behaviour and the conflict of interest these may face when allowed to practice privately. We look at the relationship between the government as the health care purchaser and principal of a two-tier hierarchy, and two hospital specialists, the agents, that deal with elective and emergency treatement. Specialists are organised in a separated structure, each responsible for only one type of surgery (either elective or emergency). We formalise specialists' preferences when dealing with the two activities. We see how specialists' interest in the income obtained with private practice (and altruism) affects negatively (positively) the optimal NHS numbers treated and increases the waiting time for elective surgery. Asymmetry of information also has a negative impact on the NHS leading to fewer patients treated or higher transfers paid. If remuneration is based on performance, transfers have to take private practice into account. As a result, there may be benefits from extra investment so as to improve information systems as well as seeking out instruments for nurturing more altruistic behaviour on the part of the specialistswaiting times and lists; elective surgery; hospital specialists

The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?

Decision-making by physicians on patients’ treatment has come under increased public scrutiny. In fact, there is a fair amount of debate on the effects of marketing actions of pharmaceutical firms toward physicians and their impact on physician prescription behavior. While some scholars find a strong and positive influence of marketing actions, some find only moderate effects, and others even find negative effects. Debate is also mounting on the role of other influencers (such as patient requests) in physician decision-making, both on prescriptions and sample-dispensing. The authors argue that one factor that may tip the balance in this debate is the role of drug characteristics, such as a drug’s effectiveness and a drug’s side effects. Using a unique data set, they show that marketing efforts – operationalized as detailing and symposium meetings of firms to physicians – and patient requests do affect physician decision-making differentially across brands. Moreover they find that the responsiveness of physicians’ decision-making to marketing efforts and patient requests depends upon the drug’s effectiveness and side effects. The paper presents clear guidelines for public policy and managerial practice and envisions that the study of the role of drug characteristics – such as effectiveness and side effects – may lead to valuable insights in this surging public debate

Healing a Broken System: Veterans and the War on Drugs

This report examines the plight of returning veterans who struggle with incarceration and psychological wounds of war such as addiction and post-traumatic stress disorder -- and suggests reforms that could improve the health and preserve the freedom of American soldiers returning from war zones and transitioning back to civilian life. Roughly 30 percent of veterans from Iraq and Afghanistan report symptoms of post-traumatic stress disorder (PTSD), traumatic brain injury, depression, mental illness or other cognitive disability. Left untreated, these medical conditions often contribute to substance misuse and addiction, fatal overdose, homelessness and suicide, as well as violations of the law, particularly nonviolent drug offenses. This report recommends alternatives to incarceration for nonviolent drug offenses, increased access to overdose prevention programs and medication-assisted therapy, and research evaluating innovative treatment modalities such as medical marijuana and MDMA-assisted psychotherapy

Use of Medicines by Community Dwelling Elderly in Ontario

OBJECTIVE: Prescription medicine use by the elderly is of growing concern as indicated by a large literature focused on rising costs, patient compliance and the appropriateness of use. However, prescriptions account for only a portion of medicines used by the elderly, who have increasing access to non-prescription medicines and natural health products. The objective of this paper is to describe overall medicine use among the elderly in Ontario. METHODS: Using the National Population Health Survey (1996/97), we describe self-reported use of prescription, non-prescription and alternative medicines among elderly Ontarians aged 65+, and we compare use among four age sub-groups and by gender. Analysis is focused on the prevalence of, and the relative balance of use of different types of medicines. RESULTS: About one quarter of the respondents reported using no prescription or non-prescription medicines in the two days prior to being surveyed; a large majority reported using two or fewer medicines only, and use of non- prescription medicines was reported more often than prescription medicines (56% vs 48%). Use of natural health products by seniors is relatively low, but we observe a trend toward increased use in younger age groups. DISCUSSION: The findings place the consumption of prescription medicines by the elderly into a broader context that reveals that much of medicine use by the elderly involves non-prescribed products. We highlight the need to better understand seniors' decision-making regarding the different types of medicines available, and the financial costs and health risks of the medicine regimes of elderly persons.elderly, medicine-use, prescription medicines, over-the-counter medicines, natural health products, NPHS

Authorized Generic Entry prior to Patent Expiry: Reassessing Incentives for Independent Generic Entry

Patent holders frequently attempt to mitigate the loss of monopoly power by authorizing generic entry prior to patent expiry (early entry). Competition in off-patent pharmaceutical markets may be adversely affected if early entry substantially impairs the attractiveness of subsequent market entry. I examine generic entry decisions made in the course of recent patent expiries to quantify the impact of early entry on incentives for generic entry. Using unique micro data and accounting for the endogeneity of early entry, I estimate recursive bivariate probit models of entry. Drug markets' pre-entry revenues largely determine both independent generic entry and early entry decisions. Early entry in turn has no significant impact on the likelihood of generic entry. Original drug producers appear to authorize generic entry prior to loss of exclusivity primarily fueled by rent-seeking rather than strategic entry-deterrence motives

The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study.

Studies have shown that early ART initiation in TB/HIV co-infected patients lowers mortality. One way to implement earlier ART commencement could be through integration of TB and HIV services, a more efficient model of care than separate, vertical programs. We present a model of full TB/HIV integration and estimate its effect on time to initiation of ART

Drug advertising directed to pharmacists in Brazil: information or sales promotion?

Análises de propaganda de medicamentos revelam importantes valores socioculturais e atitudes em um determinado contexto histórico. O objetivo deste trabalho foi analisar como a indústria farmacêutica se comunica com os farmacêuticos no Brasil, tendo a promoção farmacêutica como instrumento. O ponto de partida foi a análise de uma série de propagandas de medicamentos publicadas em três revistas técnicas dirigidas a farmacêuticos e outros profissionais de saúde. Para o presente estudo, o foco foi no conteúdo linguístico das mensagens, a fim de possibilitar uma reflexão crítica sobre o papel dos farmacêuticos no contexto da assistência farmacêutica, a partir das mensagens veiculadas pelos anúncios. A coleta e análise dos dados seguiu metodologia proposta pela Anvisa. A responsabilidade social dos farmacêuticos engloba a redução de morbidade e mortalidade relacionadas ao uso de medicamentos, mas os resultados mostram a ausência das informações necessárias à prática de uma atenção farmacêutica de qualidade. As informações divulgadas pelas propagandas referem-se basicamente ao aumento de vendas e de lucros. Longe de serem considerados profissionais da saúde, os farmacêuticos são retratados como meros vendedores. Além disso, são estimulados a vender os medicamentos que estão sendo extensamente propagandeados junto aos médicos prescritores. Discutem-se as consequências para a assistência farmacêutica.Analyses of drug advertising reveal important social and cultural values and attitudes at a certain point in history. The purpose of this paper was to investigate how pharmaceutical industry communicates with pharmacists in Brazil, using drug promotion as a valuable tool. The point of departure was the analysis of a series of drug advertisements published in three Brazilian technical journals targeted at pharmacists and other health professionals. For the present study, the focus was on the content of the messages directed to pharmacists, in order to critically analyze the role attributed to these professionals as portrayed by the ads, and to discuss it in the context of pharmaceutical care. The collection and analysis of the data followed Anvisa's methodology. Pharmacists' social responsibility includes the reduction of preventable drug-related morbidity and mortality, but the information provided by the ads only refers to sales growth and profitability. Pharmacists are portrayed as salesmen, rather than health professionals, and encouraged to sell pharmaceutical drugs which are being heavily advertised to medical doctors. Consequences for pharmaceutical care are discussed

Medical Malpractice Litigation Under National Health Insurance: Essential or Expendable?

Identification of time-continuous models from sampled data is a long standing topic of discussion, and many approaches have been suggested. The Maximum Likelihood method is asymptotically and theoretically superior to other methods. However, it may suffer from numerical inaccuracies at fast sampling and it also requires reliable initial parameter values. A number of efficient and useful alternatives to the maximum-likelihood method have been developed over the years. The most important of these are State-Variable filters, combined with Instrumental Variable methods, including the simplified refined IV method. In this contribution we perform unpretentious numerical experiments to comment on these methods, and their mutual benefits.CADIC