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Each year, about half of all U.S. doctors accept money or gifts from drug and device companies, totaling more than $2 billion. These payments range from free meals during which doctors listen to drug reps pitch their latest products, to travel to luxury locales to serve as paid “consultants.”

The conflicts of interest created by these payments are clear. Yet the medical community has resisted stopping this flow of cash, arguing that industry payments do not harm patients and may even have benefits. Few serious efforts have been made to rein in this practice. We believe stronger action — a total ban on drug industry payments to physicians — is needed. Now.

We are part of a research team at Memorial Sloan Kettering Cancer Center that recently confirmed what drug companies have long known: Industry cash influences how doctors treat their patients. We analyzed all available studies that have asked the question: Do doctors prescribe more of a drug if they receive money from that drug’s manufacturer?

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The results were unanimous: All 36 studies showed that receiving industry money increases prescribing. This was consistent across all medical specialties and types of drugs. Industry money affects how doctors prescribe cholesterol medications. It affects drugs for Alzheimer’s disease, for multiple sclerosis, and for blood thinners. It even affects which drugs are used to treat cancer. Perhaps most worrisome, it increases how many opioids doctors prescribe.

These money-fueled nudges harm patients. Accepting industry money leads doctors to prescribe expensive, worthless drugs. It leads them to choose drugs with more severe side effects when treating leukemia. It causes them to deviate from prescribing guidelines. And the increased opioid prescribing resulting from payments leads to increased deaths from opioid overdoses.

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Industry payments also contribute to rising health care costs by making doctors more likely to prescribe brandname drugs over cheaper generics. At a time when unchecked drug price increases are straining the Medicare budget and patients’ pocketbooks, industry payments are pushing things in exactly the wrong direction.

The reason a federal ban on payments is necessary is that physician-led change is unlikely. The majority of physicians believe that accepting industry payments is appropriate. As the evidence regarding the harmful effects of industry payments mounts, supporters continue to raise several arguments in defense of them.

Perhaps the most substantive argument is that doctors rely on industry to learn about new drugs. Industry payments often come with information, such as drug reps bringing slide decks to the clinic along with the catered lunch. For busy clinicians, this can be a convenient way to stay up to date. But the evidence shows that industry information is biased, which is why it makes worse doctors, not better ones.

There are numerous alternative sources — such as medical professional societies — that physicians should use to fill the informational role currently filled by pharmaceutical companies. Many medical societies have already developed reliable, unbiased information sources for doctors.

Another defense of pharma payments is that physicians working with industry drive “innovation.” Physicians’ insights, the argument goes, is essential for new cures, and paid consulting is an appropriate way for physicians to provide it. While this may be true, it is beside the point. The $2 billion per year is not for researching new drugs — industry research funding is reported separately. This money is explicitly for the promotion of drugs that are already on the market. In 2017, for example, Genentech paid more than $3 million to physicians to promote Avastin, a chemotherapy drug that has been on the market since 2004. The innovation has already happened; this money is for persuasion.

The most popular excuse is the assertion that industry payments do not truly influence prescribing. In other words, it is entirely coincidental that the doctors who accept the most cash from pharmaceutical companies also prescribe the most of those same companies’ drugs. This argument was always a stretch, and our analysis found several studies that disproved this assertion by clearly showing a causal effect. That pharma payments influence physicians’ prescribing is no longer in reasonable doubt.

There have been half-hearted efforts to curb these payments. In 2009, the Institute of Medicine urged doctors to end industry conflicts through self-regulation. They didn’t. In the hope that sunshine would serve as a disinfectant, Congress passed the Physician Payment Sunshine Act in 2010 as part of the Affordable Care Act, which required public disclosure of industry payments. But the dollars kept flowing.

The arguments in favor of industry payments no longer have traction in light of current evidence. Accepting industry money can no longer be rationalized as beneficial, or even permissible. Doctors take an oath to work in their patients’ best interests, a commitment they take seriously. The problem we must now confront is that all of the evidence suggests that industry payments run counter to what is best for our patients.

A ban on industry payments to physicians may seem drastic, but it is the only appropriate response.

Aaron Mitchell is a medical oncologist and assistant attending physician at Memorial Sloan Kettering Cancer Center, where Deborah Korenstein is chief of general internal medicine. Neither author accepts money from drug or device companies. An entry in OpenPayments suggests that Mitchell received funds in 2017 from Merck Sharp and Dohme. That money represents a research award from the nonprofit Conquer Cancer Foundation, which had received partial funding for its awards from Merck.

  • I very much appreciate your branded vs generics comments, and especially appreciate your placing the blame squarely where it belongs — on the managed care plans, which will be the ruination of health care in America.

  • I very much appreciate your branded vs generics comments, and especially appreciate your placing the blame squarely where it belongs — on the managed care plans, which will be the ruination of health care in America.

  • no mention that US citizens pay 3 to 5x for the same drug than the rest of the world no matter whether a brand name or generic one ; furthermore the FDA would never approve a generic that is harmful or ineffective by law ; the tab for all drugs in the US in year 2018 was 365 BILLION with a B or half the annual defense budget which is absurd

  • Wow! I guess myself and every physician I know totally skipped out on the lecture of “how to make extra money by prescribing unnecessary meds 101” in med school. Cut the BS and stop vilifying physicians who sacrificed their 20s and mortgaged their future with debt in order to help people. I spend a good portion of my shift looking up price options on goodrx for my uninsured patients. Even paid for some meds out of my own pocket! Shame on you!

  • Really a very short sighted article. You are stuck in 2003. The Pharma guidelines eliminated any perception of “damaging industry influence” (because as we recall “a $.08 pen” influenced prescribing habits?) You give providers very little credit. Managed care plans require providers to see 40-60 patients per day. When do providers have time to learn about new therapies and product updates? Are these “societies” you mention offering frequent new therapy tutorials during the day, at the providers convenience? NO. At an industry inservice, Providers stop in for a 7-10 minute interaction, as they inhale a sandwich, learn about FDA governed, compliant, approved product messaging, take the only break they are going to get ALL DAY, while gaining important product perspective. Is this wrong? What about all of the first line workers in the doctors office, making minimum wage, who also are supported by “the evil industry” and get to eat a sandwich?? Your misguided article will damage more people than it will help. Here is the simple premise. The FDA does not approve bad drugs. All FDA approved therapies are generally well tolerated, safe and effective. As a result, the providers have “choices” of what products to use across therapeutics areas. These choices, “benefit” patience. Yes Industry “markets” these choices, but “providers” ultimately decide. The question is, does the “sandwich” put patients heath at risk? You need to really internalize this question before you publish damaging articles. Your “branded vs generic” commentary around cost also proves you have little clarity on safety/efficacy standards of a product once it goes generic. Generics are cheaper but they are not the same. FDA standards for generic production are not the same. Most branded manufacturers assist patients with deductibles and co-pays as needed. Your witch hunt needs to be redirected as you should target the real crooks- the ones who created a “pay to play” environment- the managed care plans. Do the health plans pick the safest, most effective drugs to be on their core formulary? Absolutely not. They hold the manufacturers hostage by requiring astronomical rebates and contracts that only benefit the payer. And why? Because they can. If a product is not on the biggest plans formulary, it won’t be prescribed. It might be the best peer-reviewed product on the market, but the plan can dictate if a patient will have access to it or not. How is this ok? If BCBS requires a 60% rebate for formulary inclusion and a small manufacturer can only afford 30% who loses here? The company- certainly. But more importantly, the PATIENT. Times have changed. There is a new consumer health crisis and it isn’t coming from pharma and biotech manufacturers. Please stop the drug manufacturer bashing that has perpetuated for decades. Allow them to innovate. Allow them to bring products to providers that will ultimately save lives. Today’s problem has evolved away from the manufacturing side over to the distribution side of the business. Please, open your eyes to this reality. The public will be better informed if you do.

  • Thank you for exposing the underside of Big Pharma. Other industries stopped these practices years ago recognizing the huge potential for unethical practices. That the medical industry still allows this travesty to the detriment of the health of trusting patients is unconscionable.

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