Following established guidelines about prescription drugs would seem to be an obvious course of action, especially for the professionals that do the prescribing. Yet doctors and their family members are less likely than other people to comply with those guidelines, according to a large-scale study co-authored by an MIT economist.
Depending on your perspective, that result might seem surprising or it might produce a knowing nod. Either way, the result is contrary to past scholarly hypotheses. Many experts have surmised that knowing more, and having easier communication with medical providers, leads patients to follow instructions more closely.
The new study is based on over a decade of population-wide data from Sweden and includes suggestive evidence about why doctors and their families may ignore medical advice. Overall, the research shows that the rest of the population adheres to general medication guidelines 54.4 percent of the time, while doctors and their families lag 3.8 percentage points behind that.
“There’s a lot of concern that people don’t understand guidelines, that they’re too complex to follow, that people don’t trust their doctors,” says Amy Finkelstein, a professor in MIT’s Department of Economics. “If that’s the case, you should see the most adherence when you look at patients who are physicians or their close relatives. We were struck to find that the opposite holds, that physicians and their close relatives are less likely to adhere to their own medication guidelines.”
The paper, “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise,” is published this month in the American Economic Review: Insights. The authors are Finkelstein, the John and Jennie S. MacDonald Professor of Economics at MIT; Petra Persson, an assistant professor of economics at Stanford University; Maria Polyakova PhD ’14, an assistant professor of health policy at the Stanford University School of Medicine; and Jesse M. Shapiro, the George Gund Professor of Economics and Business Administration at Harvard University.
Millions of data points
To conduct the study, the scholars examined Swedish administrative data from 2005 through 2016, as applied to 63 prescription drug guidelines. The data enabled the researchers to determine who is a doctor; the study largely defined close relatives as partners, parents, and children. All told, the research involved 5,887,471 people to whom at least one of the medication guidelines applied. Of these people, 149,399 were doctors or their close family members.
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