Free meals influence the drugs doctors prescribe: study

Doctors who were treated to meals costing as little as $20 or less later prescribed certain brand-name pills more often than rival medicines, according to an analysis of US federal data published on Monday. And in most cases, costlier meals were associated with still higher prescribing rates for Medicare Part D drugs made by the same companies that provided the food.

The findings, published in JAMA Internal Medicine, are likely to intensify an ongoing debate over the extent to which ties between drug makers and doctors unduly influence medical practice and health care costs.

The issue has resonated over the years as prices for prescription medicines rise, and many drug companies have paid civil and criminal fines for illegal marketing and kickbacks designed to boost prescribing .

''High rates of brand-name prescribing are a pressing issue for patients and taxpayers,'' said Colette DeJong, a coauthor and research fellow at the Center for Healthcare Value at the University of California San Francisco School of Medicine. She noted there were ''great generic options'' that physicians could have prescribed instead.

''This is a huge issue for seniors receiving Medicare, who pay a median copay of $1 for generics and $80 for nonpreferred brand-name drugs [which cost patients more since insurers provide less coverage for these medicines]. Multiply this by 10 monthly medications, and it can become unaffordable for people to pick up the medicine they need,'' DeJong said.

The study examined more than 63,500 payments made to nearly 280,000 doctors, nearly 95 per cent of which were meals that cost between $12 and $18 each, and took place at restaurants, meetings, and physician offices. They also identified physicians who received meals promoting the most-prescribed brand-name drug in each class of medicine for treating high cholesterol, high blood pressure, depression, irregular heartbeats, and heart failure.

The researchers analysed data from the federal Open Payments program for the last five months of 2013, which was the first batch of data posted by the Obama administration. They also looked at prescribing data for individual doctors from Medicare Part D. Industry-sponsored meals accounted for about 80 per cent of the total number of industry payments to physicians.

Industry marketing research has shown that industry outreach to physicians encourages doctors to prescribe new drugs. And there have been other studies in the past to examine prescribing habits and industry largess, but this is the first study to cull the data and to attempt to link prescribing habits with specific types of medicines.

''This study should be another nail in the coffin of the argument that there is no association between industry marketing to physicians - even meals worth as little as $20 - and wasteful physician prescribing practices,'' DrAaron Kesselheim, an associate professor of medicine at Harvard Medical School and a faculty member at Brigham and Women's Hospital in Boston, who has studied the payments issue, told Reuters.

The JAMA researchers noted that the Pharmaceutical Research and Manufacturers of America have voluntary guidelines, which allow meals and gifts to physicians of up to $100 in value. By contrast, the American Medical Association policy prohibits industry-funded meals. But the findings suggest the industry guidelines may not be sufficient to alter industry influence and prescribing patterns.

In defence
Industry trade groups defended the meals.

''The more information prescribers obtain, the more they are likely to use a drug safely and effectively. Dinner meetings are regulated by the FDA to ensure that the information is consistent with the basic information about the drug and is not false or misleading in any way,'' said John Kamp of the Coalition for Healthcare Communication, which represents ad agencies and medical publishers.

''The fact that the doctors have dinner as part of the process does not change the facts of the presentation in any way. Education informs effective prescribing,'' he said.

A spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry trade group, wrote us that ''this study cherry-picks physician prescribing data for a subset of medicines to advance a false narrative. Manufacturers routinely engage with physicians to share drug safety and efficacy information, new indications for approved medicines, and potential side effects of medicines. As the study says, the exchange of this critical information could impact physicians' prescribing decisions in an effort to improve patient care.''

The JAMA authors noted, however, that they could not establish a cause-and-effect relationship between the prescribing and the meals.

In March, an analysis from ProPublica with cooperation from The Seattle Times, reveals for the first time that doctors who accepted payments prescribed drugs differently on average than those who did not. (See: Doctors who got more money from pharma companies prescribed more brand-name drugs: study)