Even $20 Meals Can Sway Doctors, Study Finds

Physician influence can be bought for as little as a $20 meal, UCSF researchers have found.

In a study published Monday in JAMA Internal Medicine, the researchers found that doctors who received just one meal averaging $20 were up to twice as likely to prescribe brand-name drugs being promoted than doctors who did not receive any free food.

“We really don’t think that a $5 bagel sandwich is influencing a doctor or buying a prescribing pattern,” said Colette DeJong, a fourth-year UCSF medical student and co-author of the study. “Rather, we think our findings shift the conversation to say it’s not about the money, but more about the time spent between the doctor and drug representative.”

Gifts from pharmaceutical companies to doctors — everything from pens and mugs to expensive meals, travel junkets and cash — have come under scrutiny in recent years for concerns that the money spent by drugmakers directly influences what physicians write on their prescriptions pads. Some doctors deny they’re influenced by money, but a growing number of studies show that financial ties can affect their professional behavior.

In response to such criticism, many medical centers and academic institutions started banning drug reps from pitching their products to staff on their campuses over the past decade. In 2009, the pharmaceutical industry agreed to a moratorium on giving away free branded trinkets they used to foster good will with physicians.

But U.S. doctors still receive billions of dollars each year in industry-sponsored meals and speaking fees. A recent study showed that prescribing patterns were only affected among doctors who received at least $2,000 in drug company payments.

But the UCSF researchers looked at the most common interaction between drug manufacturers and physicians: the routine briefings many doctors and their staff receive from drug reps during lunches in their offices. Those briefings often come with extra mustard or a side salad.

The study found that the effect increased as doctors got more meals. Those who received multiple meals were up to three times as likely to prescribe the promoted brand-name drug. Higher-cost meals were associated with greater influence.

“Our findings suggest that really matters,” DeJong, also a research fellow at UCSF’s Center for Healthcare Value, said. “It matters for Medicare, and it matters for patients.”

To conduct the study, the UCSF researchers relied on five months of payment and prescribing data covering all physicians who wrote Medicare prescriptions in 2013. They accessed it through Open Payments, a database created by a provision of the federal Affordable Care Act that requires drug manufacturers to disclose to all financial ties with physicians.

They studied the nearly 280,000 physicians in the database who received payments associated with four common drugs to treat high blood pressure, high cholesterol and depression. Ninety-five percent of payments were for meals, at an average cost of less than $20.

Researcher found that doctors who received four or more meals to promote Allergan’s Bystolic to treat hypertension prescribed the drug at 5.4 times the rate of physicians who received no meals. For Pfizer’s depression drug Pristiq, that rate was 3.4 times higher.

For its part, the Pharmaceutical Research and Manufacturers of America, which represents drugmakers and biotechnology companies, has a “Code on Interactions with Healthcare Professionals” that addresses informational presentations and meals.

The guidelines maintain it’s a “business courtesy” for pharmaceutical representatives to offer physicians and staff a meal during presentations and educational discussions, provided the meal is “modest” and given only on an occasional basis.

Still, UCSF researchers said that their studies show the buying power of drug makers decreases the use of cheaper, generic drugs and raises costs for patients as well as the health care system.

“Our data raises questions about current practices, but it’s also worth noting that there is not yet a standardized way to get drug information out to doctors,” said Dr. Adams Dudley, director of the UCSF’s Center for Healthcare Value and senior scientist on the study, in a statement.

He suggested the U.S Food and Drug Administration or the Centers for Medicare and Medicaid Services set up alternative means of educating doctors about drug developments.

“Given how much extra money they are spending on brand-name drugs, either Medicare or insurers would certainly see plenty of savings,” he said, factoring the cost of such educational programs.

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