Gifts and free dinners from big pharma may influence which drugs your doctor prescribes to treat your health condition, a major review has claimed.
Scientists at the Cochrane Collaboration, an organization widely considered to be the ‘gold standard’ in evidence-based medicine, analyzed data on millions of physicians and other prescribers from 93 studies, 88 percent of which were carried out in the US.
Overall, the researchers found that the drugs doctors prescribed were ‘heavily influenced’ by payments, gifts and free meals from representatives of the pharmaceutical companies that make those medications.
In particular, the scientists claimed that gifts and payments to doctors from representatives at these companies were linked to less appropriate prescribing, more prescriptions and, potentially, increased costs for patients.
Dr Lisa Bero, a medical expert at the University of Colorado Anschutz and study author, said: ‘Overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive.
‘This is problematic for a number of reasons and it matters because it directly affects patient care. These less appropriate, more expensive drugs can have fewer benefits or more side-effects than alternatives, or simply be unnecessary in the clinical context.’
Prescriptions included in the study were those for medications to treat high blood pressure, high cholesterol and depression among others. It also included prescriptions for opioid painkillers.
The researchers did not analyze studies that included harms to patients from inappropriate prescriptions, but the researchers warned that prescribing non-optimal drugs could have major repercussions for patients.
A new study found doctors who accept gifts and payments from pharmaceutical companies are more likely to prescribe unnecessary, ineffective drugs, at higher costs (stock image)
The study was based on observational studies, which cannot prove that gifts from representatives of pharmaceutical companies changed prescribing practices.
Pharmaceutical companies have previously insisted that contact with doctors is necessary, saying it helps them to ensure physicians are aware of the latest treatments for certain conditions.
Many doctors also claim that even though they accept gifts from pharmaceutical companies, it does not influence their prescriptions.
Dr Barbara Mintzes, lead study author and professor in pharmacy at the University of Sydney, Australia, said: ‘It’s very common for doctors to receive free meals from companies.
‘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.
‘The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs.’
In the study, the researchers raised concerns that the influence of pharmaceutical companies had caused doctors to prescribe less effective and more expensive medications.
They also said the findings were dose dependent. This meant that the more meals a doctor received from a pharmaceutical company, the more likely they were to prescribe that company’s medications.
For the study, published in Cochrane, researchers from four countries, including the US and UK, analyzed data from dozens of studies on doctors’ prescribing habits after receiving gifts, meals or other benefits from pharmaceutical companies.
No pharmaceutical companies were named in the review.
The above Cochrane chart shows the relationship between the number of meals doctors received from pharmaceutical companies and the number of opioid prescriptions
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The researchers analyzed papers for instances of pharmaceutical promotion and classified the promotion into one of two categories: advertising/education or gifts/payments.
Advertising or education included promotion methods such as visits from sales representatives, advertisements in medical journals, direct mailings, company-sponsored meetings, presentations sponsored by drug companies, electronic or social media promotion and financial support from drug companies for doctors to get continuing education.
Gifts or payments included meals and drinks, paying for travel expenses related to prescription drugs, conference registration, payments for services like guest speaking, advisory-board payments, speakers’ board payments and patient-education services.
Overall, the researchers found the more doctors had contact with pharmaceutical companies, the more likely it was that they would prescribe that company’s medications.
They found that advertising and education was associated with less appropriate prescribing, more prescriptions and higher prescribing costs.
Additionally, they found that doctors who received gifts or payments from pharmaceutical companies were less likely to prescribe the most appropriate medications.
Researchers also found gifts and payments were associated with added unnecessary prescriptions.
And doctors who were paid or given gifts were more likely to prescribe drugs that cost more for a patient.
Bero said: ‘Patients should be offered the most appropriate treatment for their condition, based on clinical evidence, not industry marketing.
‘The opioid crisis in North America was perhaps the most egregious example of inappropriate over-prescribing, but this was not an isolated incident. It was high-profile due to the significant harms involved, but the systems that enabled it are unfortunately considered business-as-usual within the industry.
‘Interactions between pharmaceutical companies and prescribing physicians are widespread, and the harms they cause are rarely so visible.’
The study comes as estimates suggest up to one in 10 prescription drugs in the US are overprescribed. Antibiotics in particular have an overprescription rate of 20 to 40 percent.
