ST. LOUIS New research by Saint Louis University in today's 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 Paul 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."
Other investigators involved in the study were Thomas Burroughs, Ph.D., director of SLUCOR, and Jason Swindle, MPH.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others.
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