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Doctors who take company cash are more likely to prescribe brand name drugs, analysis finds

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1645 (Published 21 March 2016) Cite this as: BMJ 2016;352:i1645
  1. Michael McCarthy
  1. Seattle

An analysis by the independent investigative news organization ProPublica has found that doctors who accept gifts or receive payments from the medical industry tend to prescribe more brand name drugs than doctors who do not accept such benefits.1

In the study, ProPublica reporters matched records of payments from drug companies and medical device makers in 2014 with data on doctors’ medication choices in Medicare’s prescription drug program, Medicare Part D, which covers more than 39 million patients. The analysis looked at doctors in five specialties (family medicine, internal medicine, cardiology, psychiatry, and ophthalmology) who wrote at least 1000 prescriptions via the program.

ProPublica reported, “Doctors who got money from drug and device makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t, our analysis showed. Indeed, doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty.”

For example, family physicians who accepted industry payments were twice as likely to be a high brand name prescriber as those who did not (relative risk 2.04 (95% confidence interval 1.92 to 2.16)), and ophthalmologists who accepted payments were more than twice as likely to be high brand name prescribers (3.63 (2.76 to 4.79)). High brand name prescribers were defined as those whose percentage of brand name prescriptions was one standard deviation or more above the mean for their specialty.

The ProPublica analysis found that doctors who received more than $5000 (£3473; €4435) from companies in 2014 typically had higher brand name prescribing percentages. The reporters wrote, “Among internists who received no payments, for example, the average brand-name prescribing rate was about 20%, compared to about 30% for those who received more than $5000.”

They noted, “ProPublica’s analysis doesn’t prove industry payments sway doctors to prescribe particular drugs, or even a particular company’s drugs. Rather, it shows that payments are associated with an approach to prescribing that, writ large, benefits drug companies’ bottom line.”

ProPublica has been tracking drug company payments to US doctors. These payments are on public record because of the Physician Payment Sunshine Act, a provision in the Affordable Care Act 2010 that requires all drug and device companies to publicly report their payments. The payments in the ProPublica analysis include promotional speaking, consulting, business travel, meals, royalties, and gifts, among others, but not payments for research.

In a statement, Holly Campbell, spokesperson for the industry group Pharmaceutical Research and Manufacturers of America, said that many factors affect physicians’ prescribing decisions, including their clinical experience, articles in peer reviewed journals, and clinical practice guidelines, and she defended the industry’s relationships with physicians.

Campbell said, “Manufacturers engage with physicians to keep them current on new indications for approved medicines, potential side effects of medicines, and both emerging benefits and risks of medicines. Physicians provide real world insights and valuable feedback and advice to inform companies about their medicines to improve patient care.”

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