To the Editor: The article in the January issue by Valenstein and colleagues (1) about the diffusion of a new antipsychotic in the Veterans Affairs (VA) health system is a useful work of reportage. However, it neglects one crucial variable, namely, the role of pharmaceutical marketing practices. As a VA clinician, I have observed a familiar series of events, in which pharmaceutical representatives first advocate the addition of their product to the formulary and then follow up with written materials and presentations, when permitted, once the new agent has been approved. Peay and Peay (2) in a study on the introduction of temazepam have shown that the most significant factor in altering physicians' prescribing was commercial sources of information. Orlowski and Wateska (3), in a study of agents similar to one another, found that differences in prescribing were attributable to attendance at a company-sponsored vacation symposium.
The pharmaceutical industry employs an array of sophisticated interventions to alter prescribers' behavior. The least we can do is to recognize their existence and study their impact. On the basis of that evidence, further responses and safeguards can be developed.