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Are Doctors Too Cozy with Drug Companies?

Do free lunches influence doctors? Most physicians would say no way. They think they always do what is best for patients. But free pizza may have an impact.

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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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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