Evidence shows a convincing association between sponsored meals and increased brand-name prescribing
Two US studies have found a strong link between industry sponsored meals for doctors and an increase in prescribing of the drug being promoted.
Industry payment and Medicare prescribing records recently became publicly available in the US, allowing researchers to look for correlations between the two.
The first study, published in May, found an association between industry payments and higher rates of prescribing brand-name statins.
Researchers found that for every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1%. Company-sponsored meals were the most frequent type of payment.
Figure info: each circle represents one physician. The solid black line is the estimated linear association between payment and brand-name statin prescribing percentage. The dashed lines represent the 95% confidence bounds around the estimated associations. Source: JAMA Int Med 2016
There was a threshold effect in the association: when the analysis was limited to doctors who received $2000 or less in total payments, the association was no longer significant.
This result is consistent with the presumption that larger industry payments to doctors are more likely to influence prescribing behaviour, say the researchers.
It is also possible that the effect on prescribing is stronger among physicians with close ties to particular companies.
The findings are “concerning”, they say, as such a dynamic contributes to the rising cost of prescription drugs.
In a second study that published in JAMA Intern Med on 20 June, a similar strong link was found.
Researchers from the San Francisco School of Medicine, among others, looked at prescriptions for statins, cardioselective β-blockers, ACE inhibitors and ARBs, and SSRIs and SNRIs.
Receipt of additional meals, and receipt of meals costing more than $20, were associated with higher relative prescribing rates of the brand-name medication being promoted.
Source: JAMA Int Med 2016
Editor-at-large of JAMA Internal Medicine, Dr Robert Steinbrook, wrote in an accompanying editorial that while none of the studies established a cause-and-effect relationship, “it is already evident that there are few reasons for physicians to have financial associations with industry”.
“There are inherent tensions between the profits of health care companies, the independence of physicians and the integrity of our work, and the affordability of medical care,” Dr Steinbrook argues.
“If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off.”