Can You Be Bought? Pharmaceutical Payment Effects on Prescribing

Written by Clay Smith

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Financial payments from the pharmaceutical industry to physicians influence prescribing behavior.

Why does this matter?
Reciprocity is almost woven into human nature. Think of the last time someone got you a gift, but you didn’t get them one. You probably felt you should give them something as well. When drug companies pay us, they know we will have an almost innate desire to reciprocate. And that is where we can get into trouble. Surely we physicians can’t be bought with a ribeye, right?

Careful accepting money from folks…
This was a meta-analysis of 36 studies, with 101 different analyses on the impact of industry payment to physicians and prescribing behavior. Thirty studies found a positive association; 6 were mixed but still showed some positive association. Payments led to increased prescribing of the specific drug in question, increased overall drug costs, and decreased use of generics in most studies. To strengthen a case for causality (which this study cannot prove), nine studies found increased prescribing of the pharmaceutical company’s drug was temporally associated with payment, and 25 of the 36 studies found a “dose-response” – more payment, more prescribing. Payments most commonly consisted of food and beverages but also consulting fees and honoraria. Another question is whether payments led to prescriptions or prescriptions led to payments (i.e. a physician was already a high volume prescriber, and payments then affirmed and reinforced prescribing habits). Actually, it’s both, and it’s hard to parse out which is more common. Most of the studies were at high risk of bias. Many studies used the Open Payments system, which may have had missing data. Also, 35 of 36 studies were based in the U.S., which may limit generalizability. Many institutions have banned clinicians from accepting anything of monetary value from pharmaceutical representatives. Mine certainly has. Gone are the days of free Preds tickets and hot wings in the drug rep box, touting the latest fluoroquinolooptyloo or cephalosomethingorother. But that’s for the best. We need to choose the drug, the right drug, and not have our thinking unwittingly clouded by reciprocity. If you accept payments, understand your brain is hard-wired to reciprocate, and it is going to take discipline and accountability to avoid it. In fact, it may not be possible.

Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing? : A Systematic Review. Ann Intern Med. 2021 Mar;174(3):353-361. doi: 10.7326/M20-5665. Epub 2020 Nov 24.

What are your thoughts?

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