A new study has suggested that meals provided to doctors, even very cheap ones, by pharmaceutical companies, influences their prescription rates of branded medications.

A little bit of food can go a long way

A new study published in JAMA Internal Medicine has shown a causative link between meals given to doctors by pharmaceutical sales reps, and the likelihood of the doctor prescribing that drug to their patients.

By looking at both the U.S Open Payments database and the Medicare Part D prescribing information they were able to spot the trend.

The study focused purely on meals provided, (though previous studies have also shown that research payments and speaking fees can influence prescription rates too.)

Cheap Meals Influence Doctor Prescriptions

The study incorporated over 276,000 doctors and four different off-patent drugs, from four different pharmaceutical companies.

The drugs analyzed were AstraZeneca’s Crestor which is a statin medication, Forest Laboratories’ Bystolic, a beta blocker, Daiichi Sanyko’s Benicar, another cardiovascular medication and Pfizer’s Pristiq, an antidepressant drug.

All four were chosen as there are generic meds available, in their same class, and the researchers considered there to be, “limited, mixed, or contrary evidence about the superiority of these 4 drugs over generic alternatives.”

And the results, well they are as disappointing as they are inevitable. If a doctor received just one cheap (less than $20) meal, they would prescribe the brand name medication to Medicare patients ““at significantly higher rates”

Colette DeJong, a fellow at University of California San Francisco’s (UCSF) Centre for Healthcare Value, and author of the study said, “To my surprise, tiny, tiny payments are associated with big differences in prescribing,”

The (disappointing) results show a clear link

Crestor prescriptions went up from an average of 470.1 from those doctors who didn’t receive a meal to a mean of 742.2 prescriptions from those that did. Likewise, Bystolic increased from an average of 299.8 prescriptions to 410 for doctors being entertained with free meal.

Doctors receiving a meal from Benicar sales reps would promote the medication 562.7, compared with just 394.8 scripts by those doctors who did not get entertained. 269.5 scripts of Pristiq was the average for doctors not getting their grub from Pfizer versus 437.6 from those that did.

There was also a correlation between the number of meals a doctor accepted from one of the pharmaceutical companies and how many times they were likely to prescribe the medication.

The most glaringly obvious was Bystolic. For doctors who were never entertained by Bystolic, they would write about 3% of their scripts for the branded medication when prescribing in that drug class, but if they received four or more meals, that shot up to a whopping 16%.

It seems quality is as important as quantity. For all the drugs except Pristine, the more expensive the meals enjoyed by the doctors were, the greater the rise in the number of scripts written.

Fair study? Plus the pharma opinion

The researchers claim the results are credible. “The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics,” the study notes.

“Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug.”

The pharmaceutical companies, who spend hundreds of millions if not billions on lobbying and public relations, have a different side of the story.

With regards free meal, they say when they come to ‘discuss’ a new drug, it saves the doctors time if they can do this in his/her office over lunch.

It was also noted that the study only looked five months’ worth of Open Payments data, compared to a full year with the Medicare script information.

The study shows what appears to be a statistically significant link between the two (food and prescriptions) but cannot prove that the meals were responsible for the greater numbers of scripts being written. The old chicken and egg argument.

Where to from here?

It is definitely a murky world when we see brand prescriptions shooting up against their generic counterparts on the back of big pharmaceutical entertainment.

If a new drug has been discovered, no one is suggesting they shouldn’t be promoting it, but there seems something suspicious if a few free cheap lunches can influence our doctors like this.

Massachusetts implemented a total ban on free meals for physicians which was repealed not long after it passed. The Open Payments database is clearly a step forward. In all things, transparency has to be a part of good governance.

Interestingly, many companies have scaled back their ‘entertainment’ and paid speaking costs as the information has become public and in January this year GSK (GlaxoSmithKline) has completely stopped using doctors as speakers.

The doctor should be above being ‘bought’ (a strong word but seems perfectly fair in this situation). Pharmaceutical companies need to be controlled much better. Remember that ultimately it is us all that foots the bill in the end.