Amid ongoing concern that painkillers other than opioids are being misused, a new analysis suggests industry payments to physicians may cause increased prescribing of a class of drugs known as gabapentinoids, which are used to relieve pain and includes the popular Lyrica pill sold by Pfizer (PFE).
After combing through a federal database of payments to doctors and running statistical models, the researchers found that physicians receiving food, gifts, and speaking and consulting fees, among other things, were nearly twice as likely to prescribe these medicines instead of lower-cost generic versions.
More specifically, between 2014 and 2016, the companies that market the three brand-name pills made nearly 510,000 payments totaling approximately $11.5 million to 51,000 doctors. Notably, these doctors represented more than 14% of physicians who prescribed any gabapentinoid under Medicare Part D during that period, according to the analysis published in JAMA Internal Medicine.
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undoubtedly most of the money paid was speaker fees. Money for lunches gains an audience for 10 minutes, and is generally a modest fund spent on sandwiches or pizza for office staff. presentations are given while everyone, including the prescribers, stop by to eat. Prescribers otherwise too busy or disinclined to give time to sales reps will give a few minutes in return for lunch for their staff.
if you’re choosing speakers to talk to other prescibers, you choose those who like and use your product. which comes first, the chicken or egg? do speaker fees induce prescribing, or does prescribing lead to paid speaking? I choose to believe most of the time it’s the latter. Ed, if you have evidence otherwise, please share it instead of constantly implying otherwise. and no, your one sentence disclaimer does not provide anything remotely like balance,
Hi Ted,
Thanks for the note.
I think we’ve had this conversation before, since these studies periodically appear. I appreciate your point, but I’m writing about studies conducted by others – I did not gather the evidence myself.
The issue of industry influence, however, has been on the table for years for a reason and while its true the patterns only suggest an association – not causation – the trends are worth noting.
And the attention paid can serve as a reminder to physicians.
All best,
ed at pharmalot
@tw
Thought I would weigh in to confirm that you are correct in one aspect of your your “chicken & egg” argument, but also wrong. True, prescribing certainly does lead to reps to call on the prescriber initially (at least prescribing within the category of drug in question, if not prescribing the rep’s specific drug.) ALSO prescribing does lead to being asked to become a paid speaker. So perhaps there wasn’t an “inducement” per se, to the prescriber in the beginning. However: 1) increased prescribing is needed to *continue* as a paid speaker, or you won’t get booked again. 2) The speaker is expected to RX a higher % of the company’s drug vs. competitors (i.e market share data will be scrutinized, and if it doesn’t show an increase over time, the speaker will be dropped, except in rare cases where there are no other speakers that can be hired.) 3) Some speakers will be picked as speakers specifically in order to increase their prescribing & grow the product market share. This individuals skill in speaking, credentials, reputation, etc. is entirely secondary to the RX growth goal. These three reasons are why academic scholars, policymakers, and journalists are correct in saying that speaker fee payments are an inducement to continue to prescribe. Don’t believe me & need other evidence? Just read the litigation documents from almost any qui tam complaint and subsequent settlement agreements between pharma & the federal government. There are dozens of examples of these that contain quotes from internal emails, rep call notes, etc. that make this connection between speaker fees & prescribing clear. (The recent Incys litigation, for example.) Or read Ben Goldacre’s 2013 book: Bad Pharma, How Drug Companies Mislead Doctors and Harm Patients, for examples, some from outside the U.S. (I worked for multiple pharma companies, over more than 15 years as a drug rep, managing hundreds of speaker programs in my territory.)
May I observe that these numbers would also indicate that physician sell themselves rather cheaply? [ “510,000 payments totaling approximately $11.5 million to 51,000 doctors. ] Or is it the frequency, implying propinquity breeds attraction? In any case, an average of 10 payment per doctor of $22.50 each time would not seem to be much of an inducement, unless multiple sales pitches over iced tea and tuna salad are very effective,
@Observer079
Seriously? Of course multiple sales pitches over a $10-$20 meal ARE effective. Duh. ROI is calculated ruthlessly. Marketing messages are about repetition. The food is less of a gift (to my mind) & more about buying a brief window of access to the office staff & prescribers.
@Former Drug Rep, it seems you have indeed confirmed my understatement. Or out it this way, “Repetition is the mother of learning.”