Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary.
OBJECTIVE
It is controversial whether physicians' interactions with drug companies affect their behavior. To test the null hypothesis, that such interactions are not associated with physician behavior, we studied one behavior: requesting that a drug be added to a hospital formulary.


METHODS
Nested case-control study.


METHODS
University hospital.


METHODS
Full-time attending physicians. Case physicians were all 40 physicians who requested a formulary addition from January 1989 through October 1990. Control physicians were 80 randomly selected physicians who had not made requests.


METHODS
Physician interactions with drug companies, as determined by survey of physicians (response rate, 88% [105/120]).


RESULTS
Physicians who had requested that drugs be added to the formulary interacted with drug companies more often than other physicians; for example, they were more likely to have accepted money from companies to attend or speak at educational symposia or to perform research (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.0 to 13.2). Furthermore, physicians were more likely than other physicians to have requested that drugs manufactured by specific companies be added to the formulary if they had met with pharmaceutical representatives from those companies (OR, 13.2; 95% CI, 4.8 to 36.3) or had accepted money from those companies (OR, 19.2; 95% CI, 2.3 to 156.9). These associations were consistent in multivariable analyses controlling for potentially confounding factors. Moreover, physicians were more likely to have requested formulary additions made by the companies whose pharmaceutical representatives they had met (OR, 4.9; 95% CI, 3.2 to 7.4) or from whom they had accepted money (OR, 1.7; 95% CI, 1.0 to 2.7) than they were to have requested drugs made by other companies.


CONCLUSIONS
Requests by physicians that drugs be added to a hospital formulary were strongly and specifically associated with the physicians' interactions with the companies manufacturing the drugs.
Chren
M M
MM
Department of Dermatology, Cleveland (Ohio) Veterans Affairs Medical Center, University Hospitals of Cleveland 44106.
Landefeld
C S
CS
D035843:Biomedical Research; D016022:Case-Control Studies; D002755:Choice Behavior; D003625:Data Collection; D004345:Drug Industry; D005572:Formularies, Hospital as Topic; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D007325:Institutional Practice / Q000191:economics; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D009820:Ohio; D011643:Publishing; D012109:Research Support as Topic / Q000191:economics