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February 28, 2013

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Thanks for your “Policy and Medicine” item today about Marissa King’s BMJ article on the effects of med school gift restriction policies. Your critique seems quite on target, but let me add a minor nit that’s worth picking.

Our institute funds research into the effects of devices and diagnostics, and does not tread into areas involving pharmaceuticals. King at al. would have been well-advised to observe the same distinction. But instead they state as their objective “To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior.”

Although med school policies may lump together the influence of pharma and device reps, that doesn’t mean they are really equivalent to one another. It’s too bad that neither the authors nor the editors seemed concerned to notice that this study produced not one shred of evidence about the effects of med school policies on the assessment, adoption, or use of medical devices. Nothing in the article justifies even the slightest mention of the medical device industry.

We don’t really know whether the patterns of conflict of interest that apply to pharmaceuticals also apply to devices. The two industries differ from one another in almost every regard, and they should be studied independently with those differences in mind. Well designed studies along these lines could be very useful for guiding appropriate education and policy decisions.

In addition to the weaknesses you identify, the King article makes the unfortunate mistake of following the example of university policymakers, and lumping the pharma and device industries together without a further thought.

Unfortunately, I’m sure this won’t be the last such occurrence.

In your conclusion you state:
"There is a significant chance, particularly given the complex nature of many of these drugs and the diseases they treat, that failing to prescribe new drugs may only further harm patients. "

I do not believe that conclusion is supported by the data. We just don't know what will happen and need to collect outcomes data also.

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