Promotional interactions between clinicians and pharmaceutical companies are probably associated with harmful outcomes, according to a Cochrane review that assessed free meals, ads and other dealings.
The researchers wanted to understand the impact of the interactions on the appropriateness, quantity and cost of prescriptions, as well as on formulary requests. To answer their questions, the team looked at 93 studies, most of which were run in the U.S. Two-thirds of the studies assessed the effect of payments, gifts or other transfers of value, while other papers analyzed the impact of ads and educational activities.
Armed with data on millions of doctors, the researchers reached the firmest conclusions on the effect of gifts and payments. Such financial transactions increase inappropriate prescribing and the quantity of prescriptions and probably raise prescription costs, the researchers said.
Digging deeper, the researchers linked the number of meals doctors receive to their prescribing of the promoted product across seven drug classes. Lead author Barbara Mintzes, Ph.D., a pharmaceutical policy specialist at the University of Sydney, Australia, outlined the importance of the finding.
“Doctors often think that this is trivial and doesn’t influence them, that they ‘can’t be bought for the price of a sandwich,’ but the data shows this is an effective marketing strategy,” Mintzes said in a statement. “The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs.”
The datasets on pharma company advertising or education aimed at doctors are smaller, covering fewer than 1,000 to more than 150,000 physicians, depending on the question. The researchers concluded that ads and educational activities probably increase the quantity of prescriptions. The activities may increase inappropriate prescribing and the costs of prescriptions, the researchers said.
After reviewing seven studies, the researchers were uncertain whether free samples affect physicians. An analysis of eight papers on conflict-of-interest policies yielded firmer conclusions. Policies restricting or managing interactions between drugmakers and doctors probably boost prescribing appropriateness and may decrease prescribing quantity, the researchers said. The effect on costs is uncertain.