Doctors deny that speaking fees, free meals, entertainment and other pharma incentives actually change their prescribing habits. They're independent, objective, too high-minded to be influenced by money.
For some physicians, this may be true. But a new study from ProPublica, which has made a mission out of tracking and analyzing the cash and handouts pharma deals to doctors, adds more data to the mounting evidence of what common sense suggests: Payments and gifts do influence many doctors when they pull out their prescription pads.
ProPublica paired the Open Payments Database, where drugmakers now report their payments and gifts to doctors, with Medicare prescribing data to link dollars to drugs. They found that the doctors who took payments and gifts from drugmakers in 2014 were more likely to prescribe branded drugs that year. Even small handouts--such as free meals and payments worth $100 or less--tweaked branded scripts upward. Doctors who participated were two to three times more likely to prescribe brands than those who didn't.
There was also a dose response: The bigger the value of payments and gifts, the more branded scripts, ProPublica found. Doctors who received more than $5,000 in a year's time chalked up the highest percentages of branded scripts.
As an example, ProPublica noted that, internists who did not rack up any payments, gifts or meals, prescribed branded drugs about 20% of the time on average. Brands accounted for 30% of prescriptions written by doctors who collected $5,000 or more.
These statistics are like all population-level statistics: They demonstrate tendencies, trends. Individual prescribing habits obviously vary. And the analysis, ProPublica notes, doesn't break payments and prescriptions down to the brand level.
Some previous research has drawn specific links. According to a study published by the Social Science Research Network, doctors who accepted free meals, speaking fees, consulting payments and so on from a particular drugmaker were more likely to prescribe branded products made by that same drugmaker--not only compared with competing brands in the same category, but when compared with cheap generic versions, too. Even cheap generics of that very brand-name product.
The 2013 study, which also drew on ProPublica's cache of payments and Medicare prescribing data, compared physicians' use of two different branded statin drugs--Pfizer's ($PFE) Lipitor, which faces direct generic competition, and AstraZeneca's ($AZN) Crestor, which did not at the time. Pfizer payments were associated with an increase in Lipitor branded scripts, and AstraZeneca payments with Crestor prescriptions. "Moreover, we find that payments from either company reduce the fraction of generic statin alternatives prescribed," the study authors wrote.
Drugmakers say their speaking programs provide a valuable educational service, and providing free meals--lunch in a doctors' office, for example--gives physicians time to sit down and learn about new products from pharma reps. The industry association PhRMA has defended pharma's financial ties with physicians, saying that drugmakers help inform better decision-making by paying expert-caliber speakers to spread their knowledge.
Still, the practice of paying doctors to speak on behalf of drugs has grown controversial in recent years, partly because of some high-profile scandals involving highly paid physicians. Buying lunch--even coffee--for doctors isn't critic-free either; Massachusetts briefly instituted a ban on free meals for physicians, a move unpopular with restaurateurs. Some drugmakers ratcheted back their payments to doctors after the Open Payments database went public, as ProPublica research has shown. GlaxoSmithKline ($GSK) went so far as to back off of doctor-speakers altogether, as of January 2016.
One type of funding hasn't dropped, and that's pharma backing for continuing medical education. These payments aren't disclosed, and a Boston Globe investigation last fall found that pharma funding for private CME courses increased by 25% since 2011. A hotel workers union upset about CME funding started a campaign--called, appropriately enough, "No More Drug Money"--to stop industry-funded CME. The union, Unite Here, says the payments unduly influence doctors and contribute to rising healthcare costs.
- see the ProPublica coverage, via NPR
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