pizza coming out of a wood fired oven

Most doctors think they are way too smart to be influenced by drug companies. Physicians believe that they choose the best medicine for their patients based on science, not bribery.

For decades many doctors in America accepted free lunches for themselves and their staffs. In many cases it was “just” pizza. But drug companies often tried to outdo their competitors. Especially influential and busy clinics sometimes got gourmet meals. This practice seemed so innocuous that it was taken for granted. It went along with the pens, pads, calendars, coffee mugs and other doodads drug companies love to give away. Most physicians convinced themselves that such innocuous gifts had no impact on prescribing patterns. They were certain that little gifts did not lead to favorable treatment for drug companies.

Free Lunches DO Make A Difference!

A study published in JAMA Internal Medicine (August, 2016) demonstrated the power of all those free lunches to influence prescribing patterns. Even cheap food had an impact. The researchers were able to track how much money the pharmaceutical industry spent on things like speaking fees, travel expenses, gifts and meals. Using the Medicare database called “Open Payments” they discovered that 279,669 physicians “received 63,524 payments associated with 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20.”

The target drug categories were:

  • Statins, in particular rosuvastatin (Crestor)
  • Blood pressure pills: nebivolol (Bystolic) and olmesartan (Benicar)
  • Antidepressants: desvenlafaxine (Pristiq)

Here is what the researchers discovered:

We found that the receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted.

As compared with the receipt of no industry-sponsored meals, we found that receipt of a single industry-sponsored meal, with a mean value of less than $20, was associated with prescription of the promoted brand-name drug at significantly higher rates to Medicare beneficiaries. The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics. Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug.”

The authors were cautious and added this caveat: “The findings represent an association, not a cause-and-effect relationship.” 

We are not so cautious. When there is a “dose-response-relationship” in pharmacology we think that is convincing evidence. What we mean is that if a little dose produces a modest effect and a big dose produces a substantial effect, we conclude that the drug was causing that outcome. When a modest meal influences prescribing patterns a little bit and a costlier meal has a greater impact, we conclude that the meal is responsible for the “desired” effect on prescribing patterns.

No Free Lunch for Patients:

This is not the first time research has suggested that physicians can be influenced by drug industry largesse. Some doctors get handsome fees for consulting for the pharmaceutical industry. Others are considered “thought leaders” and get paid to give lectures to their colleagues. Some of these programs are over dinner at fancy restaurants. Industry payments have been linked to greater prescribing of the promoted medication.

Sadly, patients are stuck with the bill either in the form of higher drug costs out of pocket or higher insurance premiums. They get no free lunches.

Years ago AstraZeneca fired one of its managers after his motivational comments to the sales force were leaked to the public. Mike Zubillaga was a regional sales director for cancer drugs. In an internal company newsletter he was quoted as saying:

“There is a big bucket of money sitting in every [doctor’s] office. Every time you go in, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money.”

Doctors Do The Selling for Drug Companies:

Less controversial was Mr. Zubillaga’s exhortation to use doctors to spread the drug company’s message to other doctors through speaker programs. This is a common tactic within the industry.

A survey of 1,662 physicians published in The New England Journal of Medicine (April 26, 2007) revealed that 94 percent:

“reported some type of relationship with the pharmaceutical industry.” Over three fourths acknowledged accepting free food or drug samples. One third of the doctors surveyed were reimbursed for expenses, “including the costs of travel, time, meals, lodging or other personal expenses for attending meetings and free or subsidized admission to meetings…”

Most alarming of all, more than one fourth of the doctors in this survey were paid by drug companies for services such as consulting, lecturing or signing up patients for clinical trials. Influential doctors are more likely to receive large honoraria or consulting fees.

“Best Practices” and Guidelines:

Specialists love to encourage their colleagues to follow “best practices.” What a great name. No one wants to follow worst practices or second-best practices. It is the “thought leaders” who end up writing guidelines about best medical practices. Powerful physicians can sway their peers to select certain medications over others to treat conditions like high blood pressure, depression, diabetes or heart disease.

Despite protests to the contrary, it is hard to imagine that a cardiologist who receives more  than $100,000 from a pharmaceutical company will not favor that company’s cholesterol-lowering medicine.

What is particularly worrisome about all the free food and gifts, not to mention the outright payments, is that they appear to be increasing. In 2002 pharmaceutical manufacturers adopted a new code of conduct. It was supposed to limit the freebies and guarantee that physician-industry interactions “should primarily benefit patients and enhance the practice of medicine.”

Studies in recent years suggests that Big Pharma has intensified its outreach to doctors and patients. It is almost impossible to turn on the television without seeing commercials for powerful prescription medicines. These commercials not only affect patients, they also impact doctors’ prescribing patterns.

Whether these efforts have improved health is anyone’s guess. What is clear, however, is that the cost of medications keeps going up. When doctors prescribe the most expensive drugs the pharmaceutical companies take their big buckets of money to the bank.

Revised: 3/22/17

Share your own thoughts about free lunches and other gifts below in the comment section. Do you like those prescription drug commercials you see on TV? We’d like to get your feedback.

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  1. rose
    SD
    Reply

    I do not believe commercials should be allowed for drugs. I have heard the drug companies spend more on advertising than research.

  2. J. David Auner
    Springfield, MO, USA
    Reply

    I am ambivalent about big pharma’s efforts to oversell their products.
    The Good: Medicine practices are parochial in many ways. Bringing outside experts to talk about a drug or disease state(mostly in conversation after the lecture) has helped my patients by the hundreds every year of practice. A Ritz-Carleton function lead to questioning a Mass. Gen. CHF researcher who had been treating with ACE and ARB agents combined and seeing “high” potassium levels without deleterious effects. My information about potassium, magnesium, renal artery hypertension, and falls in the elderly were greatly expanded that day. Another lower budget pharma presentation on migraines exposed me to the Shealey, Cady, Schreiber theories and experience which helped make sense of migraines and relieve HA’s for most of those patients.

    The Bad: Prepared materials by drug companies shade some details and ignore general concepts, parsing fine definitions of words to promote certain inferior drugs. The FDA is not immune from putting out pure BS(half the time?) which is used by pharma to promote their product. Selacryn was a diuretic which spared potassium and magnesium and would have been a useful niche drug. In the effort to make the drug a billion dollar profit center, it was oversold, combined with other drugs in complicated patients, killed a number of patients and was taken off the market.

    Unfortunately, that was the beginning of the era where corporations killed people and nobody went to prison. The last drug company presentations I attended were horrible. One of the toxic atypical major tranquilizers($$$$) was cast as the best way to prevent suicide in bipolar patients – clearly a concocted theory by somebody without a good understanding of the disease and when those patients kill themselves. The Psychiatrist presenting did take back his assertion when challenged but the case illustrates the problem with canned presentations for bad drugs.

  3. Shirley
    Reply

    I absolutely HATE the medical commercials on TV. When I hear “ask your doctor etc.” I immediately mute the TV and do something else while the commercial goes on and on. I’m threatening to stop watching the evening news on ABC because of all the medical commercials. Why do the drug companies put the burden on the patient to ask the doctor for drugs when it’s the doctor’s responsibility to advise the patient what medicine they need? Also I wish they would stop advertising the men’s medicine for ED during the evening news when families with children are sitting down to dinner. Can’t they pick a better time when men are watching sports?
    age 88 and fed up with the medical ads on TV !

  4. Mary Jane
    NYC
    Reply

    We KNOW that doctors are in bed with Big Pharma. Why even raise it as a question?

  5. Dori
    Reply

    Absolutely, most docs hand out drug prescriptions much too freely. I have changed to an integrational MD and at 80 take just one Rx and that’s for natural thyroid.

  6. Carol Anderson
    Texas
    Reply

    I totally despise the drug commercials. So many of them and repeated so often that I can repeat them word for word. When a commercial is so annoying, I make it a point never to buy that product.

  7. Gerry
    Florida
    Reply

    We’d be better off with more natural ways to combat our diseases but of course in this day and age that is not very popular. I take allergy pills due to what could be life-threatening if I didn’t know which pills to take, angioedema, hives beneath the surface of the skin. When my tongue tingles, I take a benedryl as that’s the signal that whatever food I’ve eaten too much of is bothering me: acids and all salicylates are most common triggers. Since my doctor and the internet educated me, I have lived now 17 years without major allergic reaction (anaphylaxis). I take quite a few vitamins. I refused to take warfarin after surgeries since I take Vitamin A Palmitate (made from shark livers I believe) which is blood thinning enough.

  8. Mark
    Cary, NC
    Reply

    Most busy physicians do not have the time in their busy practices to keep up with the latest literature/information on current therapies. If a pharma rep brings in a modest meal for the office at lunch, this can be a great time for that doctor to learn more about the product, dosing, side effects, etc. And, remember, for each company providing a lunch, so is the competition, so no particular drug is getting a foot up. I believe that MOST (obviously not all) doctors are using sound logic when Rx’ing a medication. I for one, would not want to see a doctor that is not seeing drug reps.

  9. Lorna
    NC
    Reply

    All forms of bribery, no matter how monetarily insignificant, should be eliminated from physicians’ practices. Legislators who receive bribes from drug companies should recuse themselves from participating in legislation affecting that industry or refuse their funding. Drug advertising should be eliminated as a cost to the drug industry that drives up the cost of medications to American citizens. Information on prescriptions citizens purchase should be labeled with the country where it is grown or manufactured; China, India, etc., as many citizens think they are made in US when it may just be packaged or distributed in US.

  10. Beverly
    TX
    Reply

    I believe there should be laws to prevent this kind of activity. Also, I believe too many doctors are concerned with their bottom line and not the welfare of their patients.

  11. Rita
    Arkansas
    Reply

    For starters, I feel strongly that TV ads for prescription drugs should be illegal. Not only are they misleading, they drive up costs. Unfortunately, many people want a “magic pill” rather taking some responsibility for their own health by eating healthful food (e.g, the Mediterranean diet), being more physically active, and so on.

  12. EE
    Reply

    So this explains why my rising TSH levels were ignored and I was left on a super-low dosage of thyroid supplement and put on that statin that I had to stop taking after just 3 weeks because it was affecting my muscles and kidneys.
    Maybe this is why they won’t refer me to a specialist for my hypothyroidism, too. If that gets fixed, bye-bye high cholesterol without resorting to statins. Of course there is the claim that statins help people with kidney problems, and I do apparently have damage from a serious childhood kidney infection, but I don’t think I want to risk them with statins again. Especially since it took the statins for me to become aware of it.
    Incidentally, my “dangerously high” cholesterol was just over 200 and my “skyrocketing” triglycerides were 150. Oh, and I am high risk for heart disease because my mother, after a lifetime of absolutely no heart disease, died of heart failure in her sleep. For some reason, maybe it is having sat by the bedside of elderly relations dying of other things like cancer, my thoughts about that are that I hope God is that kind to me.
    I have no intention of taking something that makes me sick for the next 30 years to prevent a peaceful death in my 80s.

  13. Witheld
    Reply

    I agree with this article and I think that the free meds and even lunches are fine. However, worse is the fact that medical organizations and societies are just “fronts” for the pharmaceutical industry as they are heavily funded by them.
    I was previously employed by the National Medical Association which is an association of black doctors. Over 80% of all of their revenue came from the drug companies either from the convention (this year Hawaii) which is always held in some expensive city where doctors and familes are wined and dined or from the “journal” which is another front for drug promotion. The organization would be called and asked to speak up for a pharmaceutical industry issue and true to form, they would if they were given enough money.
    This organization is supposed to represent black physicians and patients– it really is a hoax and a disgrace. I want to be clear, most black doctors don’t belong to the organization– despite what they put in print…while I worked there only about 1,700 physicians belonged although they would put that over 20,000 were members in the publications. I think that this is a crime.
    The conferences which we had to attend as employees were filled with huge exhibits and the scientific meetings were barely attended and were usually just promotion for a drug. Each year the drug companies are paraded in and given “awards” based on how much money they gave to the organization. In the meantime, patients suffer while doctors continue to take the perks. I had to leave and am now working another organization that has absolutely no drug company influence and I can sleep better at night.

  14. Barbara Koch
    Reply

    The first time my cholesterol was tested was in the 1980’s and I was in my mid fifties. My reading was over 300. I took Zocor for many years. When I started to experience leg pain I was switched to Lipitor. My cholesterol has been as low as 130. I will be eighty next month.

  15. Jodi Milligan
    Reply

    Whenever the doctor discover another problem with my health, I RUN to the natural
    remedies section and look up
    what I can use. Don’t run to the pharmacy first, do alittle research first.(Example: I had a traumatic incident with hemorraging a year or so ago. I decided to quit taking coumadin. Instead, I take fish oil to keep my blood from clotting. Much better for me and alot easier to control!

  16. Fred Randall
    Reply

    My cardiologist, who knows I have had severe myopathy in my legs (MD) possibly caused by statin drugs, insists that Lipitor is a must and that it should be put into the drinking water!

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