Doctors treated to a meal by a pharmaceutical company are more likely to prescribe the company’s brand-name medication, according to a study published in JAMA Internal Medicine, an influential academic journal published by the American Medical Association.
Widespread media reports of the study in June, such as a National Public Radio article titled “Even A Small Meal For A Doctor Can Tip The Balance For A Brand-Name Drug,” commonly suggested the study found a causal relationship between meals and prescriptions, contrary to the study’s conclusion.
“The findings represent an association, not a cause-and-effect relationship,” states the study’s abstract, last updated in August.
The study analyzed industry payment data from the federal Open Payments Program and prescribing data for individual physicians participating in Medicare Part D. Nearly 280,000 physicians received more than 63,000 “payments,” 95 percent of which were meals costing $20 on average, associated with four drugs targeted by the study, the abstract states.
Doctors who received a promotional meal from the drug’s manufacturer prescribed the drug at higher rates than doctors who did not receive a meal, and “receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates,” the abstract states.
Dr. Richard Dolinar, a clinical endocrinologist and pharmaceutical industry consultant, says the articles promoting the study ignore the educational value of meals drug companies give doctors for the purpose of promoting a drug.
“The purpose of advertising and marketing is to inform and to persuade,” Dolinar said. “Such meals provide a way for doctors to learn and keep up with the latest in medicine. To imply that a doctor is going to change his prescribing habits because he was provided a free ‘rubber chicken meal’ is laughable.”
John R. Graham, a senior fellow at the National Center for Policy Analysis, says the study shows only that meals are associated with higher prescription rates, not that doctors are prescribing drugs improperly.
“Whether doctors are ‘swayed’ or not is unimportant,” Graham said. “What is important is whether the drugs are prescribed appropriately, which is not addressed in the study. If the drugs are under-prescribed, then we need some mechanism to increase prescriptions. The implications are unclear until we know the clinical outcomes of the prescribing.”
State and federal regulations grant doctors a government-protected monopoly over prescriptions, limiting patients’ health care options, Graham says.
“It is normal free-market behavior for a producer to sell its product to its customers,” Graham said. “What is different in health care is doctors have a monopoly power to prescribe medicines, granted to them by state licensing laws and the [U.S. Food and Drug Administration]. They are the gatekeepers through whom drugs must pass.”
Michael McGrady ([email protected]) writes from Colorado Springs, Colorado.
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