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?
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.
Industry payments also contribute to rising health care costs by making doctors more likely to prescribe brand–name 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.