Doctors who were fed meals costing even less than $20 later prescribed certain brand-name pills more often than rival medicines, according to a new analysis published on Monday of a federal database. And in most cases, costlier meals were associated with still higher prescribing rates for Medicare Part D drugs made by the same companies that provided the food.
The findings, published in JAMA Internal Medicine, are likely to intensify an ongoing debate over the extent to which ties between drug makers and doctors unduly influence medical practice and the nation’s health care costs. The issue has resonated over the years as prices for prescription medicines continue to rise, and many drug companies have paid civil and criminal fines for illegal marketing and kickbacks designed to boost prescribing.
“High rates of brand-name prescribing are a pressing issue for patients and taxpayers,” said Colette DeJong, a coauthor and research fellow at the Center for Healthcare Value at the University of California, San Francisco School of Medicine. She noted there were “great generic options” that physicians could have prescribed instead.
I probably am missing the point here, but it seems to me that maybe these “studies” are showing that big Pharma has successful marketing plans. Now, if I owned stock in those companies, I’d be happy to know that. That IS what marketing is about…increasing sales…umm…isn’t it?
Marketing may be about increasing sales, but medicine is — or at least should be — about making decisions in the best interest of the patient (not the pharma company) based on evidence (not gifts).
Well…I suspect this type of gratuity is only indicating a ‘tip of the ice berg’.
Robert, your choice of the term ice berg is prescient. I once attended a product launch meeting in which the open bar featured a 25′ x 50′ ice sculpture with the name of the drug that obscured everything else in sight.
Contrary to what your picture shows, the most we have gotten was pizza for the office staff. This was inadequate compensation for spending our lunch hour listening to the benefits of a new product. I suppose the sales reps salaries and their budget should be better spent to enrich an already powerful television media and the Boston Globe. (Just how much did Medicare save by the pharmaceutical tv advertising with the words “ask your doctor” attached to them?)
As physicians, we do not have the fortitude of the average Ivy League school who is bankrolled by Middle Eastern oil money or, let us say, a secretary of state who receives $400000 for a 25 min speech to Wall Street while apparently attacking these same donors.
Hi M. Douek,
Thanks for taking the time to write. Here’s a question – why do you feel you should be compensated for taking the time to learn about a new product? Why is it unreasonable to expect physicians to learn, on their own time, about new products and procedures as part of their work?
I’m interested to know your point of view.
ed at pharmalot
Since doctors usually close their offices for lunch it s money that is not being made anyway. Since it’s a waste of you time ask the rep to purchase you a journal subscription or a textbook. Goldman- Cecil Textbook of Medicine list for $177 but with a group practice you can get under the $100 limit. That assumes you still read up on your patients.
“Cherry-picking” or not, the question remains: if there’s no connection between meals and gifts to physicians and their prescribing behavior, why have pharma reps (whose compensation depends entirely on whether physicians prescribe their drug) continued this practice for over five decades?
Article seems to have an agenda to suggest that doctors who have a lunch or dinner are swayed in a negative way to use a new drug. Having first hand knowledge of this process most physicians have little time during their busy day to learn about new drugs or talk and share experiences with other doctors who may be prescribing the drug. Why not do an article that interviews a group of doctors on why they would use a new drug? In the vast majority of cases there are legitimate reasons that a new drug offers some significant treatment benefit which significantly increases the patient quality of life that was not being met with a current medication.
Hi BL Stein,
Thanks for the note. I’m not sure if you were referring to the JAMA paper or the post here, but for the record, there is no agenda involved in reporting this study. Simply tried to present the findings along with interpretations and reactions, from both sides of the fence, so to speak.
In any event, thanks for taking the time to discuss this.
ed at pharmalot
We do interview doctors in groups using focus group techniques. The Pharma.guys sit behind one way mirrors and observe. Problem is they have to be run at night, the doctors must travel to the studio and you have to feed them anyway.
The dinner meetings are excellent educational opportunities for community based physicians to hear lectures by prominent physicians in their field. The $20 dinners are not a bribe. This type of sponsored educational meetings occur in every type of human endeavors from lawyers, accountants to plumbers and electricians. Stop fixating on doctors.
The problem with outrageous drug prices is not with the doctors, it is with the fact that Medicare is prohibited by law from negotiating drug price and must pay whatever prices the drug companies set for Medicare approved drugs, which is usually 10 to 100 times the prices for the same drugs in Europe, India or Canada.
Fix Medicare pricing system, and see the cost of drug drop rapidly.
Is it reasonable to consider that perhaps the physicians practice of prescribing could possibly be related to increased awareness and knowledge of pharmaceuticals with better safety and efficacy profile?
Correlation is not causation. Could it be that the reps providing meals were aimply “selling”…aka, doing their jobs? As i understand it, many thinga out of sight are out of mind. Aggressively selling a product should result in higher sales, as I understand it.
Yes, aggressive selling should increase sales. But increased use of a medicine should depend upon actual evidence that using that medicine is in the best interest of patients, not on aggressive selling.
Given the drek I’ve eaten at these dinners the food should be a disincentive. As for lunches the doctors don’t care about the food; they barely have time to eat. The food is mostly to pacify the office staff. The food us soon forgotten; it’s the metric ton of reminder ads and other “leave behinds” that are more important.
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