How Much Influence Do Medical Publications Have On Your Doctor? A Great Deal, Sa

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How Much Influence Do Medical Publications Have On Your Doctor? A

Great Deal, Says New SLU Research

http://www.medicalnewstoday.com/medicalnews.php?newsid=54441

New research by Saint Louis University in the Journal of the

American Medical Association asks two intriguing questions: How much

impact do articles in prominent medical journals really have on how

doctors treat patients, and how fast does that impact affect

clinical practice?

The answers? Quite a bit, and very quickly - if the news is

negative.

Researchers from the Saint Louis University Center for Outcomes

Research studied nearly 400,000 hospital admissions of heart failure

patients before and after two articles appeared in Circulation and

JAMA in early 2005 suggesting nesiritide, a popular medication for

acute decompensated heart failure, had an increased risk of kidney

failure and death.

After the articles were published, nesiritide use in heart failure

patients fell from a peak of 16.6 percent in March 2005 to only 5.6

percent in December 2005. The decreases were greatest in the

elderly, reflecting heightened concerns about risks in this

population.

" The results were notable - and to a large extent unexpected, " says

J. Hauptman, M.D., cardiologist at Saint Louis University

School of Medicine and lead author. " Not only did doctors appear to

change practice when confronted with a potential safety problem, but

they also did so far more rapidly than we expected. "

Hauptman says this is remarkable, considering that earlier studies

have shown that the opposite is true.

" When medications are shown to improve survival, it takes doctors

longer to adopt them into practice, " he says.

Likening it to the effect articles in Vogue have on the fashion

industry, co-author Mark Schnitzler, Ph.D., associate professor of

medicine at Saint Louis University, says articles in major medical

journals have tremendous influence over physicians.

" Most doctors, academic or not, read JAMA and the New England

Journal of Medicine, " Schnitzler says. " Most are probably just

scanning the articles or monitoring media coverage of the articles,

but they believe they can trust the information being presented. Now

we know that the information does have a very real effect on the

doctor-patient relationship. "

Researchers already know a good deal about why - and how quickly -

doctors begin using new drugs to treat their patients, Hauptman

says.

" But much less is known about the factors that lead to a decrease in

the use of a particular drug, " he says.

Using a database of 491 acute care hospitals in the United States,

the team studied 385,627 heart failure patient records in: the four

months preceding the two articles and the eight months following;

the same time periods in 2004 for comparison; and the eight months

preceding the launch of nesiritide in 2001.

The researchers also hypothesized that doctors would increasingly

prescribe competing drugs to treat heart failure. In fact, the use

of most drugs for the condition did not increase. However, among

patients prescribed intravenous drugs to treat heart failure (aside

from diuretics), use of inotropes increased, which Hauptman says is

noteworthy because there is extensive research on the potential risk

of death with this class of drug.

Their findings, say team members, have far-reaching implications.

" With an increasing focus on drug safety, we need to recognize that

the publication of research that calls into question the safety of a

drug can have a great impact on physicians, and, as a consequence,

on patients and drug companies, " Hauptman says. " Whether these

effects would occur with other drugs or devices remains to be seen.

In the meantime, 'keeping up with the latest medical research' takes

on a whole new meaning. "