Large long-term clinical trials have helped to define first-line drug therapies for conditions such as high blood pressure.1 Physician adherence to evidence-based guidelines, however, has been modest at best,2 and the causes remain unclear. In a study of antihypertensive drug use in 10 countries, Fretheim and Oxman3 characterized the international variation in prescribing patterns. The prescription of thiazides, for instance, was 4-fold higher in the United Kingdom than in Norway, and conversely, the prescription of α-blockers was 4-fold higher in Norway than in the United Kingdom. The authors hypothesized that these international differences were related in part to the promotion of more expensive drugs in Norway through “seeding trials,” which have been described as “thinly veiled attempts to entice doctors to prescribe a new drug being marketed by the company.”4
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