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Do drug industry perks affect prescribing? Yes says recent study

Do drug industry perks affect prescribing? Yes says recent study

Picture of Martha Rosenberg

Ask any doctor who has accepted money from the drug industry whether a $20 meal or a four digit “speaker’s fee” and he or she will tell you “it does not affect my prescribing.” Ask them if the same compensation affects other prescribers and they will heartily agree. The belief that we are somehow unaffected by something that affects everyone else, whether advertising or financial incentives, runs deep in human nature either because of vanity or denial. Unfortunately, it is usually not true.

Most would guess that an all expense-paid trip to a resort as the drug industry regularly offered groups of doctors until fairly recently would produce indebtedness and boost prescriptions but a recent study in JAMA Internal Medicine found that even a lowly, $20 meal resulted in more prescriptions.

The study found doctors who received even one free meal were 70% more likely to prescribe the brand name beta blocker Bystolic, 52% more likely to prescribe the brand name ACE inhibitor Benicar, 118% more likely to prescribe the brand name antidepressant Pristiq and 18% more likely to prescribe the brand name statin Crestor. Preference for the drug linked to a free meal existed even though generic equivalents exist for all four drugs which significantly save patients and the health care system money. The study found that more than one free meal increased the likelihood of doctors prescribing the drugs with the exception of Pristiq.

Of course doctors can take umbrage at the suggestion that they “can be bought for a hero or a slice of pizza,” said the study’s lead author R. Adams Dudley, a professor of medicine and health policy at the University of California, San Francisco. But “it is human nature for a doctor to reciprocate by listening to the pitch of a sales representative bearing free food or beverages.”

Even though the 2010 Physician Financial Transparency Reports (also called the Sunshine Act; part of the Affordable Care Act) was expected to lessen Pharma “freebies” to doctor by making all payments public, in the last five months of 2013, more than half of U.S. doctors were still enjoying free meals, gifts and outright payments from Pharma. In 2002, Pharma’s lobbying group PhRMA adopted a voluntary code discouraging free trips and tickets to the theater or sporting event for doctors but the code still allows free meals.

An editorial accompanying the JAMA Internal Medicine study said,  "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. 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." It is an understatement.

Medical professionals have accused journalists of putting undue focus on industry payments, maintaining that it does not affect their prescribing and also that the world has bigger problems. But journalists hew to a strict “no gifts” code themselves. According to the Reuters’ Handbook of Journalism, professional journalists do not accept “any payment, gift, service or benefit (whether in cash or in kind) offered by a news source or contact,” “hospitality when there is no news value” or travel “junkets.” Journalists must pay their own way on trips to maintain “accuracy, balance and the truth,” says Reuters and other reputable news organization adhere to the same standards.

At medical conferences, doctors often show slides disclosing all the drug companies who pay them before segueing into their “objective” medical study. Imagine what would happen if a journalist disclosed financial payments from an entity or industry and then proceeded to “report” on it.

Portions of the report appeared earlier on

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