Even cheap meals provided by pharmaceutical sales reps were associated with higher prescription rates for the brands being promoted, a new JAMA Internal Medicine study concluded.
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Physicians who received meals related to the targeted drugs on four or more days per year prescribed the drugs 1.8 to 5.4 times more than physicians who did not receive industry-sponsored meals.
A new study has discovered that doctors who were bought meals by drug companies had a higher tendency to write prescription of a branded drug instead of an equivalent drug which costs much cheaper.
R. Adams Dudley, MD, of UC San Francisco, and his coauthors linked to two national data sets to quantify the association between industry payments and physician prescribing patterns.
Often a pharmaceutical salesperson will give a doctor a presentation about a new or existing drug and offer to do so over a free lunch, or snacks, and doctors are more likely to listen to their pitch if they can eat lunch at the same time, Dudley said.
According to NBC News, Dr. Dudley and his colleagues analyzed prescribing information for four popular drugs from approximately 280,000 Medicare physicians and found that the doctors in the study received some kind of benefit, almost all meals, worth $20 or less in which the four drugs like cholesterol-lowering drug rosuvastatin (brand-name Crestor), the blood pressure drugs nebivolol (brand-name Bystolic) and olmesartan medoxomil (Benicar) and the antidepressant desvenlafaxine (Pristiq) were mentioned. These included statins to lower cholesterol levels; beta-blockers, most often used to treat high blood pressure; angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), also used to treat high blood pressure; and selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), approved for treatment of depression.
“The more information prescribers obtain, the more they are likely to use a drug safely and effectively”. It is a practice that is designed by the industry to lead to prescriptions of more expensive, current, brand name drugs.
Jerry Avorn, a professor of medicine at Harvard Medical School who was not involved in the research, said the study was an improvement over past research because it narrowly examined doctors who received meals promoting a specific drug and their prescription behavior.
The UCSF study was made possible by public disclosures of payments from manufacturers to physicians that have been required since August 1, 2013, under the Physician Payments Sunshine Act, which is part of the Affordable Care Act. Ninety-five percent of payments were for meals, at an average cost of less than $20. Elsewhere, medical ethnicists and watchdogs have repeatedly warned about the damaging effects that financial incentives can have on doctors’ ability to provide the best health care for their patients.
Marketing guidelines established by the American Medical Association and Pharmaceutical Research and Manufacturers of America (PhRMA) allow meals and gifts to doctors worth up to $100.
The issue has resonated over the years as prices for prescription medicines rise, and many drug companies have paid civil and criminal fines for illegal marketing and kickbacks created to boost prescribing.
Study’s co-researcher Colette DeJong said that they have also noticed an exception that Pristiq’s prescription rate declined after a third day of receiving a sponsored meal. Physicians who did receive meals paid by the industry are inclined to prescribe their drugs.
“It’s not that it’s medically bad” for patients, Dudley said.
Nearly 280,000 doctors received a total of more than 60,000 payments associated with the four target drugs. “But if you go in there with some doughnuts and the nurse says to the doctor, ‘There are crullers in the conference room, ‘ the doctor goes in there of their own free will. Humans, when they receive gifts, feel some urge to reciprocity”.
Payments for food and beverages provided to doctors totaled $224.5 million in 2014, JAMA Internal Medicine editor-at-large Robert Steinbrook, M.D., noted in an accompanying editorial.
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“There are inherent tensions between the profits of health care companies, the independence of physicians and the integrity of our work, and the affordability of medical care”, he wrote.
