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Free meals from drug companies linked to doctors’ prescribing habits, study finds

Could a free meal from a pharmaceutical company be all it takes to get physicians to increase their prescriptions of a drug the company is promoting?

Apparently so — at least, according to the findings of a study published online Monday in JAMA Internal Medicine.

Previous research has shown that industry payments to physicians (say, for speaking fees, travel expenses and education in the form of free textbooks and journal articles) can influence doctors’ prescribing habits. But just how much has to be spent on a doctor before his or her prescription habits change has been a matter of debate. At least one prior study suggested that the payment had to be substantial — more than $2,000. 

The new study found, however, that a single $20 meal might also change the drug choices that doctors make.

Pharmaceutical companies seem to know this. In 2014, according to an editorial that accompanies the new study, “payments for food and beverages, by far the most frequent type of payment to physicians, totaled $224.5 million.”

Study details and key findings

For the current study, a team of researchers led by Dr. R. Adams Dudley, a professor of medicine and health policy at the University of California, San Francisco, analyzed two U.S. government databases from 2013. One database contained information on industry payments to physicians. The other tracked physicians’ prescriptions for drugs paid for by Medicare Part D. 

Dudley and his colleagues focused on only four prescription drugs for this study: three brand-name cardiovascular drugs (AstraZeneca’s Crestor, Forest Laboratories’ Bystolic and Daiichi Sankyo’s Benicar) and one antidepressant (Pfizer’s Pristiq). These drugs were chosen because each had an effective and lower-cost generic alternative available.

The data revealed that 279,669 physicians during the period of the study received 63,524 payments (with a total value of $1.4 million) from companies associated with the four drugs. About 95 percent of those payments were for drug-company-sponsored meals that had, on average, a value of less than $20 each.

Yet, despite being relatively cheap, those meals were associated with a significant increase in prescriptions. Physicians who accepted free meals on four or more days from the companies marketing the study’s target drugs were significantly more likely to prescribe the drugs than physicians who received no such payments. They were 5.4 times more likely to prescribe Bystolic, 4.5 times more likely to prescribe Benicar, 3.4 times more likely to prescribe Pristiq, and 1.8 times more likely to prescribe Crestor.

Even receiving a single free meal increased the physicians’ prescription rates of these drugs, although the greater the number of meals — and the more they cost  — the stronger the association.

A caveat

That word — association — is important. Because of the study’s design, its findings represent only a correlation, not a cause-and-effect relationship, between free meals and higher numbers of prescriptions.

It’s possible, as Dudley and his colleagues point out, that physicians may choose to attend an industry-sponsored luncheon or dinner event to learn more about drugs that they already prefer. In those cases, being wined and dined may not have an effect on their prescribing patterns.

Still, as the accompanying editorial points out, pharmaceutical companies “are not charities; clearly they believe that billions of dollars of investments will have good returns.”

‘Is it necessary?’

“Our findings support the importance of ongoing transparency [regarding physician-industry relationships] efforts in the United States and Europe, Dudley and his colleagues conclude.

It seems to be time — past time — to argue about the necessity of that transparency, as the author of the editorial, Dr. Robert Steinbrook, an editor-at-large at JAMA Internal Medicine and an adjunct professor of internal medicine at the Yale School of Medicine, points out.

“Is it necessary to prove a causal relationship between industry payments to physicians and the prescribing of brand-name medications?” he asks. “Other than research support, product development, and bona fide consulting related to specific research programs and projects, it is already evident that there are few reasons for physicians to have financial associations with industry. Outright gifts, such as meals, may be legal, but why should physicians either expect or accept them?”

“If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off,” he adds.

FYI: The study and the commentary can be found on the JAMA Internal Medicine website. 

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Comments (5)

  1. Submitted by Ray Schoch on 06/21/2016 - 11:48 am.

    No surprise

    No one should be surprised by this. Physicians, being human, are just as subject to being influenced by freebies and flattery as the rest of us ordinary mortals might be.

    “…It’s possible, as Dudley and his colleagues point out, that physicians may choose to attend an industry-sponsored luncheon or dinner event to learn more about drugs that they already prefer. In those cases, being wined and dined may not have an effect on their prescribing patterns.

    Still, as the accompanying editorial points out, pharmaceutical companies “are not charities; clearly they believe that billions of dollars of investments will have good returns.”

    The important point is that pharmaceutical companies are NOT charities. They expect a return on their “investment,” even if the “investment” is no more than rubber chicken at some sort of association banquet.

    As elections approach, we might want to keep those same issues of transparency in mind for every level of elected official. Since corporations have been deemed “persons” by the law, at least for the time being, and corporations are, by definition, NOT charities, it’s reasonable to assume that:

    A) transparency regarding campaign contributions, which is resisted at every level by companies all over the country, would be a very useful tool for citizens trying to determine if a particular official was “in the pocket” of some corporate vested interest; and

    B) those same corporate “persons,” not being charities, likely want to see some measurable return on their investment of campaign contribution cash. If physicians can be influenced by sums as small as $20, it’s reasonable to assume that election candidates might well be influenced by campaign contributions of thousands of dollars from corporations and individuals.

  2. Submitted by Ron Gotzman on 06/21/2016 - 11:51 am.

    Are politicians removed from such influence?

    You mean business try to “buy” customers the same way special interests “buy” politicians?

    • Submitted by Ray Schoch on 06/21/2016 - 04:19 pm.

      That’s my point

      Not sure your analogy is quite what I meant, though it might be. What the study in the article suggests is that pharmaceutical companies “buy” doctors in pretty much the same way they “buy” Congressmen and women. Both are swayed by the companies involved – Congressional representatives and Senators by campaign contributions, vacations, etc., from “big pharma,” and physicians by much the same thing, but on a smaller scale.

      The result is that Congress voted to prohibit the federal government from negotiating with pharmaceutical companies over prescription drug prices for programs like Medicare and the ACA, and a good many physicians prescribe brand-name drugs produced by those pharmaceutical companies instead of less expensive – but equally effective – generic drugs.

  3. Submitted by Frank Phelan on 06/21/2016 - 03:09 pm.

    If A Meal Can Buy Influence

    With a doctor, imagine what happens when the drug peddlers fly a doc and her family to a sunny destination for a “conference” in January!

  4. Submitted by joe smith on 06/22/2016 - 07:54 am.

    Americans are in worse shape than ever.

    It is much easier to take a pill advertised to cure your ills than it is to make a life style change for health. Doctors are not miracle workers they are just human beings being pushed into a quick fix by big pharma. No different than politicians. Once politicians figured they could bribe the public with the publics money and get wealthy doing it, things changed for the worse.

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