Author Affiliations: Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (Dr Psaty) and Institute for Health Policy Studies, University of California, San Francisco (Dr Rennie). Dr Rennie is also Deputy Editor, JAMA.
Large long-term clinical trials have helped to define first-line drug therapies for conditions such as high blood pressure.1 Physician adherence to evidence-based guidelines, however, has been modest at best,2 and the causes remain unclear. In a study of antihypertensive drug use in 10 countries, Fretheim and Oxman3 characterized the international variation in prescribing patterns. The prescription of thiazides, for instance, was 4-fold higher in the United Kingdom than in Norway, and conversely, the prescription of α-blockers was 4-fold higher in Norway than in the United Kingdom. The authors hypothesized that these international differences were related in part to the promotion of more expensive drugs in Norway through “seeding trials,” which have been described as “thinly veiled attempts to entice doctors to prescribe a new drug being marketed by the company.”4
Psaty BM, Rennie D. Clinical Trial Investigators and Their Prescribing PatternsAnother Dimension to the Relationship Between Physician Investigators and the Pharmaceutical Industry. JAMA. 2006;295(23):2787-2790. doi:10.1001/jama.295.23.2787