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Gifts — big and small — from drug companies influence how doctors prescribe, study finds

Prescribing drugs
REUTERS/Brian Snyder
The providers given gifts averaged 892 prescriptions each — more than twice as many as the 389 prescriptions for providers who were given none.

Physicians and other health care providers who receive meals, speaking fees, trips, grants and other “gifts” from the pharmaceutical industry prescribe more drugs per patient — and more expensive drugs — than providers who did not receive such financial favors, a new study has found.

Even small gifts (less than $500 a year) had an impact on prescribing, but the larger the monetary worth of gifts, the greater the effect.

“Our study confirms and expands upon previous work showing that industry gifts are associated with more expensive prescriptions and more branded prescriptions,” the study’s authors write. 

“State and Federal governments should consider restricting pharmaceutical marketing on the grounds that it compromises public health,” they add. “Industry gifts influence prescribing behavior, may have adverse public health implications, and should be banned.”

A large number of gifts

The study, which was published in the journal PLOS One, analyzed data from 2,873 health care providers in the Washington, D.C., area who wrote prescriptions in 2013 through Medicare Part D, the federal prescription drug program for people who are aged 65-plus or disabled.

The providers included not only doctors, but nurse practitioners, physician assistants and others who can prescribe medicine through Medicare Part D.

In addition to supplying information on the providers’ individual prescribing patterns, the data also revealed the amount each provider received in gifts from various pharmaceutical companies.

The study found that almost 40 percent of the providers accepted a total of $3.9 million worth of gifts in 2013, ranging from as little as $7 a year (the cost of a box of doughnuts) to as much as $200,000 a year in cash.

The providers given gifts averaged 892 prescriptions each — more than twice as many as the 389 prescriptions for providers who were given none. They also handed out more prescriptions per patient (8.8 versus 6.5) 

In addition, the gift recipients prescribed 7.8 percent more brand-name drugs, which are more expensive than generic ones. One in three prescriptions (33.5 percent) written by the gift recipients were brand-name drugs compared to one in four (25.7 percent) written by the non-gift recipients.

Not surprisingly, the average cost of the prescriptions by the providers who received gifts was $135 compared to $85 for the others.

Any gift was associated with more expensive prescribing. The average cost of prescriptions by providers who received what the researchers call “small gifts” (less than $500 annually) was $114 — $29 higher than that by the providers who received no gifts.

But physicians who received “large gifts” (more than $500 annually) had the highest average cost per prescription ($189). Brand-name drugs were also a larger proportion (39.9 percent) of their total prescriptions. 

‘A powerful effect’

“This study clearly shows that even small gifts change the practice of medicine,” said Dr. Adriane Fugh-Berman, the study’s senior author and director of PharmedOut, a project on drug prescribing based at Georgetown University Medical Center, in a released statement. “Gifts, no matter their size, have a powerful effect on human relationships, and pharmaceutical companies are well aware of that.”

As Fugh-Berman points out, such gifts cost taxpayers money. But that’s not the only implication of this study that troubles her and her colleagues.

“Our finding that gifts from pharmaceutical companies result in more prescriptions per patient is particularly concerning,” said study co-author Susan Wood, a professor of health policy at George Washington University, in the released statement, “because the more medications a patient takes, the higher the risk of adverse effects.”

Industry gifts — of any amount — should not be permitted, they conclude.

FMI: You can read the study in full on the PLOS One website.

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Comments (1)

Looks like direction of causation may be mixed

Associational studies always leave one wondering about the direction of causation. In this case, the direction may be different for some effects than for others. The gift recipients are prescribing substantially more generic drugs than the non-recipients. That suggests to me that their overall high level of prescription may be exogenous: the pharmaceutical companies may be targeting their gifts to high prescribers, rather than the gifts causing the recipients to become high prescribers. On the other hand, the gifts may be causal with regard to the recipients' higher proportion of brand-name drugs (7.8 percentage points higher, not 7.8 percent higher). Seen from a pharmaceutical company's perspective, this makes sense. It is worth spending money on a heavy prescriber to shift their prescribing more in favor of your name brand drug.