April 13, 2016
If your doctor receives money or gifts from a drug company, be it payment for a lecture or a free meal, does it influence the medications he or she in turn prescribes? This represents the burning question in an industry saturated with pharmaceutical company involvement.
A ProPublica analysis revealed nearly nine in 10 cardiologists, and seven in 10 internists and family practitioners, included in their study received payments from drug or device companies in 2014.1 But the analysis didn’t stop there.
It also looked into whether or not such payments were associated with prescribing practices, and here’s where things got interesting.
Doctors Who Received Drug-Company Money Prescribed More Brand-Name Drugs
ProPublica analyzed the prescribing habits of doctors who wrote at least 1,000 prescriptions in the Medicare Part D drug program. The doctors belonged to five common specialties: psychiatry, cardiovascular disease, family medicine, internal medicine and ophthalmology.
Not only was the receipt of drug-company money associated with a higher percentage of brand-name drug prescriptions, but the prescriptions rose with the amount of money received.2
The analysis included promotional speaking, consulting, business travel, meals, royalties and gifts as forms of drug company payments. Those who received more than $5,000 from industry in 2014 prescribed the most brand-name drugs. According to the analysis:
“In all cases, the group receiving larger payments had a higher brand-name prescribing rate on average.
Additionally, the type of payment made a difference: those who received meals alone from companies had a higher rate of brand-name prescribing than physicians who received no payments, and those who received speaking payments had a higher rate than those who received other types of payments.”
Are Drug-Company Payments ‘Thinly Veiled Kickbacks?’
Dr. Aaron Kesselheim, an associate professor of Medicine at Harvard Medical School, told The Atlantic regarding the featured study:3
“It again confirms the prevailing wisdom … that there is a relationship between payments and brand-name prescribing … This feeds into the ongoing conversation about the propriety of these sorts of relationships.
Hopefully we’re getting past the point where people will say, ‘Oh, there’s no evidence that these relationships change physicians’ prescribing practices.'”
Indeed, this is far from the first time that such payments have been linked to prescribing practices.
A 2010 study published in the Archives of Internal Medicine also found that nearly 84 percent of physicians surveyed reported some type of relationship with industry during the previous year, and those with such a relationship were more likely to prescribe a brand-name drug even when a generic alternative was available.4
The finding isn’t only relevant for patients, who may be paying more unnecessarily for brand-name drugs, but also for taxpayers who spend billions each year subsidizing Medicare Part D. At least 1 in 4 U.S. prescriptions are paid for by Medicare.
Meanwhile, it’s worth repeating that the reason drug companies pay doctors and aggressively promote certain medications is not to benefit patients; it’s to benefit their bottom line. And there’s often a fine line between legitimate payments and illegal kickbacks. ProPublica noted:5
” … [F]ederal whistle-blower lawsuits against several pharmaceutical companies have alleged that payments are little more than thinly veiled kickbacks, which are illegal. Companies have paid billions of dollars to settle the cases.”