Informational Shocks, Off-Label Prescribing, and the Effects of Physician Detailing

Abstract

The relationship between pharmaceutical detailing and prescriptions for non-FDA-approved (off-label) use has been the subject of regulatory scrutiny, with more than $12 billion in regulatory settlements for off-label promotion since 2004. Using the case of AstraZeneca’s antipsychotic drug, Seroquel, I study the extent to which off-label prescriptions are caused by detailing. Using a physician panel that connects detailing exposure to medical charts, I exploit within-physician variation to identify detailing effects. I find the effect of detailing on off-label prescriptions is small in both absolute and relative terms. Detailing on net tilts the prescribing distribution toward on-label. This paper was accepted by Eric Anderson, marketing.

Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D

“…Grennan et al (2018) study how payments in the form of meals affect cardiologists' prescribing of statins and find that payments increase prescribing by 73 percent. Shapiro (2018a) finds that a detailing visit (which may or may not involve a payment) increases prescribing of the antipsychotic Seroquel over the years 2001 to 2006; his estimates imply an increase of about 14 percent in the following twelve months. 19 Agha and Zeltzer (2019) study anticoagulants ("blood thinners") and find that small payments increase prescribing by 10 percent while large payments increase prescribing by 65 percent.…”

Conflicts of Interest and Steering in Residential Brokerage

“…Our results on steering behavior also resonate with other work documenting that consumers often receive advice from experts that is not in their interest. For example, Mullainathan, Noeth, and Schoar (2012) ;Christoffersen, Evans, and Musto (2013); and Del Guercio and Reuter (2014) study financial advisers and broker recommendations for mutual funds; Jiang, Stanford, and Xie (2012) analyze bond ratings; Schneider (2012) ;Anagol, Cole, and Sarkar (2017);and Shapiro (2015) examine the auto repair, insurance, and health industries, respectively.…”

How do Physicians Respond to Malpractice Allegations? Evidence from Florida Emergency Departments

“…More broadly, our paper relates to a large literature on physician behavior and variation in practice styles. This literature has studied the influence of physicians' financial incentives (Clemens and Gottlieb, 2014), diagnostic decision-making (Abaluck et al, 2016;Currie and Macleod, 2017), practice environment (Chandra and Staiger, 2007;Molitor, 2018), beliefs about treatment (Cutler et al, 2019) and response to new information (Cutler, Huckman and Landrum, 2004;Dranove et al, 2004;Kolstad, 2013;Shurtz, 2013;Shapiro, 2017;Sarsons, 2019). Our results complement this literature by addressing differences in practice style due to differential exposure to the malpractice system.…”