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?
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.
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.