title: Restrictions on pharmaceutical detailing reduced off-label prescribing of antidepressants and antipsychotics in children.
abstract: The treatment of pediatric depression is controversial because it includes substantial prescribing of drugs for uses that have not been approved by the Food and Drug Administration ("off label") and are not evidence based. Some academic medical centers (AMCs) restrict "detailing" by pharmaceutical sales representatives, or the promoting of drugs directly to physicians via sales calls, to reduce the effect of such marketing on physician prescribing. With data from thirty-one geographically diverse AMCs and their affiliated hospitals, we used a difference-in-differences model to estimate the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006-June 2009. We found that after the introduction of such policies, prescriptions for off-label use of promoted drugs fell by 11 percent, consistent with the ongoing presence of off-label marketing to physicians. Prescriptions for on-label use of promoted drugs fell by 34 percent after the adoption of the policies. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for off-label use of nonpromoted drugs rose by 35 percent. These results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing.
authors.affiliation: Ian Larkin is an assistant professor of business administration at the University of California, Los Angeles.
authors.forename: Ian
authors.initials: I
authors.lastname: Larkin
authors.affiliation: Desmond Ang is a PhD candidate in economics at the University of California, San Diego.
authors.forename: Desmond
authors.initials: D
authors.lastname: Ang
authors.affiliation: Jerry Avorn is a professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, in Boston, Massachusetts.
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.affiliation: Aaron S. Kesselheim (akesselheim@partners.org) is an assistant professor of medicine at Harvard Medical School and director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kesselheim
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000331:legislation & jurisprudence*; D000329:Advertising / Q000331:legislation & jurisprudence*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002665:Child Psychiatry; D004345:Drug Industry / Q000331:legislation & jurisprudence*; D004363:Drug Utilization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D040541:Marketing / Q000331:legislation & jurisprudence*; D056687:Off-Label Use / Q000331:legislation & jurisprudence*; D010372:Pediatrics / Q000331:legislation & jurisprudence*; D014481:United States
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Children’s Health; Hospitals; Legal/Regulatory Issues; Pharmaceuticals; Public Health