Abstract

There remains considerable controversy over whether and how sales visits from pharmaceutical salespeople (“detailing”) affect physician prescribing, particularly because detailing visits often involve the provision of small gifts and/or product samples. Physicians overwhelmingly claim they are not influenced by these visits or the gifts and samples that salespeople give them, and existing evidence is mixed and largely non-causal. This study exploits policy changes around permitted interactions between doctors and salespeople at major Academic Medical Centers (AMCs) in the United States, 15 of which enacted strict regulations between 2006 and 2010, and 8 of which did not. It uses a comprehensive prescribing database encompassing all physicians in these AMCs (over 10,000 total) and all 218 drugs within nine major drug classes. The introduction of AMC detailing policies significantly increased market shares of non-detailed drugs and reduced market shares of detailed drugs, compared to the control group of AMCs that did not change policies. Bans on personal gifts such as meals and branded items accounted for nearly all of this effect. Personal gift bans increased the market share of non-detailed drugs by 4.9% (p<0.001) and decreased the market share of the average detailed drug by 6.2% (p=0.001). Banning educational gifts had no incremental effect (p=0.20). Limits on site access and samples provisions did not affect prescribing (p>0.13 in all cases). The study’s results support the hypothesis that gifts influence physicians primarily via non-informational mechanisms, such as reciprocity.

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