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Trials on hormone therapy and hypertension treatment change practice, medication usage of patients

reported drug use by 54 percent (from 2.26 million to 1.03 million). Other potential influences did not appear to have contributed significantly to this decline although cessation of alpha-blocker marketing may have hastened the decline."

" ... our findings are clearly consistent with ALLHAT early termination results having a significant impact on alpha-blocker use. Declining pharmaceutical industry promotion also may have contributed further to decreased alpha-blocker use. The lack of an abrupt and more pronounced decline in prescribing shortly after the ALLHAT results, however, suggests slow and potentially incomplete diffusion of information from this clinical trial. Combined with past work that questions the potency of clinical trial results on physician practice, our analysis suggests the need for additional strategies to augment the dissemination of results from clinical trials," the authors conclude.

(JAMA. 2004; 291:54-62. Available post-embargo at JAMA.com)

Editor's Note: This study was supported by a research grant from the Agency for Healthcare Research and Quality.

EDITORIAL: THE COMPLEX WORLD OF PRESCRIBING BEHAVIOR

In an accompanying editorial, C. David Naylor, M.D., D.Phil., of the University of Toronto, Ontario, Canada, discusses the articles in this week's JAMA examining how clinical trials and other factors influence how physicians prescribe medications.

"In the complex realm of prescribing behaviors, physicians now process ever-increasing amounts of evolving evidence in contexts with their own unique micro- and macro-sociology, where the economic incentives are not infrequently perverse. Prescribers must individualize therapy and consider combinations of drugs for which randomized evidence may be limited," he writes.

"The pharmaceutical industry markets its wares relentlessly to physicians and consumers alike and exerts
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Contact: Randall S. Stafford
650-724-2400
JAMA and Archives Journals
6-Jan-2004


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