According to new study doctors who receive free meals from drug makers are more prone to prescribe the brand-name drugs those companies sell.
Physicians who got just one free meal, price less than $20 on average, twice more likely to prescribe a promoted brand-name drug than a lower priced generic alternative, compared with doctors who did not get a meal.
Doctors who who got several meals were up to three times more likely to prescribe those drugs.
"To my surprise, tiny, tiny payments are associated with big differences in prescribing," said study author Colette DeJong, a research fellow at University of California San Francisco's (UCSF) Center for Healthcare Value.
Additional meals and higher price were linked with even higher prescribing rates of the promoted drug.
"So whether you get zero, one, two, three or four meals has a step-wise increase in the prescribing of the brand-name drug that's being promoted, and that has huge implications for Medicare and huge implications for patients," said DeJong.
Marketing guidelines set up by the American Medical Association and Pharmaceutical Research and Manufacturers of America (PhRMA) allow gifts to doctors up to $100 worth.
"Although voluntary guidelines from the American Medical Association and Pharmaceutical Research and Manufacturers of America allow meals and gifts to physicians of up to $100 in value, our findings indicate that even payments of less than $20 are associated with different prescribing patterns," they added.
"Small payments and meals should continue to be monitored in the United States."
Most of the meals in the study were of very low value. "It's more like the pizza in the doctor's office than the formal dinner out," DeJong noted.
Dr. Adams Dudley, director of UCSF's Center for Healthcare Value addressed that It's not the value of the gift driving doctors' prescribing patterns; it's "feeling like you owe the drug rep something," he said.
Similarly, a Harvard Medical School study published in May discovered that Massachusetts doctors prescribed a bigger proportion of brand-name statins — the category of drugs that treat high cholesterol — the more industry money they got. There was no big increase in brand-name prescribing for those who received less than $2,000.
Most Medicare beneficiaries are in prescription drug plans where the median copay is $1 for generics and $40 to $80 for brand-name drugs, DeJong noted.
"You can imagine for a senior on 10 or 20 medicines, that's a huge cost every month," she said.
However, the study did not prove a cause-and-effect relationship. It might be that doctors go to industry events where information is provided on drugs they already like.
“The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics,” the study states. “Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug.”
The study was published online Monday by JAMA Internal Medicine.
