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Healthy Skepticism Library item: 19162

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Hansen RA, Chen SY, Gaynes BN, Maciejewski ML
Relationship of pharmaceutical promotion to antidepressant switching and adherence: a retrospective cohort study
Psychiatr Serv 2010 Dec; 61:(12):1232-8


OBJECTIVE: Patient nonadherence and
early discontinuation of
antidepressant treatment are common.
Pharmaceutical promotion to
consumers and physicians may
influence this behavior. The
objectives of this study were to
explore whether promotional spending
is related to early antidepressant
switching, acute-phase adherence,
and continuation-phase adherence.

METHODS: A retrospective cohort
study was conducted with national
promotional expenditure data merged
with medical and prescription claims
data from a large national health
plan affiliated with i3 Innovus.
Included were records for
continuously insured adults with
major depression who received a new
prescription for an antidepressant:
5,010 were in the cohort assessed
for switching, 4,457 were in the
cohort assessed for acute-phase
adherence, and 1,772 were in the
cohort assessed for
continuation-phase adherence.
National promotional efforts were
estimated by examining
inflation-adjusted spending on
direct-to-consumer advertising
(DTCA) and physician detailing.
Clinical guidelines were used to
create proxies for aspects of
treatment outcomes, including
antidepressant switching and
adherence in the acute phase and
adherence in the continuation phase.
Logistic regression models estimated
the association between promotional
variables and these outcomes.

RESULTS: Patients taking medications
that were more highly promoted to
physicians were less likely to
switch medications (odds ratio
[OR]=.61) and were more likely to be
adherent during the acute phase of
treatment (OR=1.13). DTCA had little
effect on switching or
antidepressant adherence.

CONCLUSIONS: Detailing to physicians
was associated with lower rates of
medication switching and had a
positive relationship with patient
adherence during early
antidepressant treatment. This
finding indicates that certain
aspects of promotion may have
beneficial effects on antidepressant


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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909