Experience of VA psychiatrists with pharmaceutical detailing of antipsychotic medications

The interaction between physicians and the pharmaceutical industry has become a subject of increased interest and concern. This study surveyed a national sample of psychiatrists practicing within Department of Veterans Affairs (VA) medical centers in 2005. It specifically focused on the experiences of these physicians with representatives of the manufacturers of second-generation antipsychotics.

VA psychiatrists were invited by e-mail to complete a Web-based questionnaire about their contact with representatives of each of the relevant pharmaceutical companies. Respondents were then questioned about several potential assertions about treatment effectiveness, side effects, and costs of these drugs.

Of the 1,833 potential participants, 639 (35%) visited the Web site and completed the questionnaire. Among the responders, 558 (87%) reported at least one contact with company representatives. In the year before the survey the percentage of respondents reporting contact with representatives of each individual company varied from 58% to 70%. The three most commonly reported assertions made at any time in the past through direct speech during those meetings were that the representative's second-generation antipsychotic resulted in "a decreased risk of extrapyramidal symptoms" (79%), "greater symptom reduction than placebo" (78%), or "better negative symptom control than conventional antipsychotics" (77%). Statements least likely to be reported included that drugs resulted in "better positive symptom control than conventional antipsychotics" (36%), "better positive or negative symptom control than another atypical antipsychotic" (38%), and "increased risk of the development of diabetes mellitus" (39%).

Comparing assertions reportedly made to VA psychiatrists with package insert information suggests that many assertions made by drug company representatives are inconsistent with prescribing information approved by the U.S. Food and Drug Administration, although assertions consistent with package insert information were more common than inconsistent ones.