Giving someone a box of donuts may seem like a harmless gesture, but for pharmaceutical companies it could boost sales. A new study of healthcare providers in the District of Columbia finds that gifts of any size influence prescribing behavior among physicians.
An analysis of Medicare Part D prescription data encompassing almost 2,900 providers in the DC area in 2013 shows gifts of any size can drive higher prescribing rates for high-cost and brand-name pharmaceuticals. The study’s results, published in the journal PLOS One, found that among the physicians and providers in the study, nearly 40% accepted gifts ranging in value from $7 to $200,000 a year.
Pharmaceutical companies’ returns on those investments included prescribing rates over twice as high as those providers who did not receive gifts, and a nearly 8% increase in brand-name drug prescriptions, say researchers from Georgetown University Medical Center and George Washington University Milken Institute School of Public Health.
“Gifts, no matter their size, have a powerful effect on human relationships, and pharmaceutical companies are well aware of that,” the study’s co-senior author, Adriane Fugh-Berman, MD, of GUMC said in a statement.
Previous studies have traced the influence of pharmaceutical sales practices across various channels and practice areas. For example, the majority of physicians who post on Twitter have issues with undisclosed financial ties to drugs they mention on the platform.
FierceHealthcare has also reported on the pharmaceuticals industry’s role in the opioid epidemic, with a study showing one in 12 physicians received payments from drugmakers that sell prescription opioids.
Fugh-Berman, who also directs PharmedOut, a research and education project targeting pharmaceutical prescribing and marketing practices, suggested in the announcement accompanying the study’s release that the industry ban gifts entirely.
No national laws currently prohibit such gifts, according to the announcement. A recent study published in JAMA, however, did note that academic medical centers that restricted marketing by drug company reps saw an increase in generic prescriptions after doing so.
The cat’s out of the bag. Again. And it’s time to act, decisively.
I like what one of the study authors had to say about physician gifts:
“Every slice of pizza given to a physician compromises patient health,” says Dr. Fugh-Berman, director of PharmedOut. “Industry gifts influence prescribing behavior, cost taxpayers money and should be banned,” she adds.
Susan F. Wood, PhD, professor in the department of health policy and management and director of the Jacobs Institute of Women’s Health at George Washington University’s Milken Institute School of Public Health also points out:
“Our finding that gifts from pharmaceutical companies result in more prescriptions per patient is particularly concerning, because the more medications a patient takes, the higher the risk of adverse effects.”
Fugh-Berman and Wood are the study’s co-senior authors.
While previous research has raised the issue of influence of pharmaceutical gifts on physician care, this study is unique in that it looks not only at doctors, but at other providers of medical care including nurse practitioners (NP), physician assistants (PA), podiatrists and others who reported prescribing medicine using Medicare Part D.
Gift acceptance was associated with a significant increase in the average cost per claim for PAs ($213 vs. $63) and NPs ($180 vs. $86). Gift acceptance by PAs was also associated with a significantly higher proportion of branded claims (30.2% vs. 17.0%); NPs who accepted gifts did not have a significantly higher proportion of branded claims (18.3% vs. 16.9%). Gift acceptance by podiatrists was not associated with a higher average cost per claim or proportion of branded claims.
The authors note that pharmaceutical companies clearly influence healthcare providers’ attitudes and therapeutic choices through financial incentives that include research grants, educational grants, consulting fees, speaker fees, gifts, and meals.
Ironically, although pharmaceutical company promotion influences a physician’s prescribing behavior, studies have consistently shown that physicians do not believe that promotion affects their own prescribing.
We all know in our heart of hearts that the long-standing custom of drugmakers paying doctors to write prescriptions for their medicines. That includes our regulators. And, yes, there aren’t any laws dealing with this precise practice.
But that doesn’t mean it’s OK. Still, nothing has changed. For me, it’s all about the notion of “corruption.” And it brings me back to the principal reason for why I believe in China’s gradual, inevitable ascendance to the world’s most powerful nations–namely, stamping out widespread corruption.
Unlike President Trump’s election promise of draining the swamp–something we now gag at with all the lies, corruption and mayhem rife in his administration–China’s President Xi Jinping has kept his promise.
Do we really have to resort to China-like steps to curb abuses like these pharma-sponsored gifts to doctor? Yes, in my opinion. Otherwise, as I’ve written before, it’s business as usual. And we citizens ultimately pay for such abusive practices.
Furnishing healthcare providers with educational materials that don’t hype a specific medicine is one thing–perfectly appropriate. But, as for the purely marketing-oriented gifts mentioned herein, I’m siding with those who say it’s time for Congress to ban this practice in its entirety.