In healthcare, small gifts can lead to a big influence

$20 doesn’t sound like much, right?

We’re talking about less than the cost of two tickets to a movie, a new book, or dinner at a middle-of-the-pack restaurant. This sounds even more minuscule in the context of healthcare more broadly. After all, we collectively spend some $3 trillion on health each year, and $20 amounts to less than 1% of health expenditures per person per year.

But $20 has a lot more power than you think.

In fact, based on a new study, a $20 meal for a physician picked up by the pharmaceutical industry is all it took to show significantly higher rates of prescribing highly prevalent and lucrative brand-name drugs.

Thanks to the Open Payments Program, which I discussed in this previous post, we now have a much better glimpse into the extent of gift-giving within healthcare from industry to physicians.

In this study, published in JAMA Internal Medicine, researchers looked at data within the Open Payments system between August 1 – December 31, 2013 and prescribing data for physicians from Medicare Part D. They specifically wanted to know if industry-sponsored meals for physicians (which make up some 80% of all industry payments to physicians) had an influence on Medicare prescriptions in four  drug classes: statins, cardioselective β-blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACE inhibitors and ARBs), and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs).

This figure is a good summary of what they found: the more days physicians received a sponsored meal related to a particular drug, the higher the prescribing rate of that drug compared to physicians who didn’t receive any sponsored meals.

drugs and sponsored meals

The authors describe it in more detail:

“Physicians receiving meals related to target drugs on 4 or more days prescribed rosuvastatin at 1.8 times the rate (15.2% vs 8.3%), nebivolol at 5.4 times the rate (16.7% vs 3.1%), olmesartan at 4.5 times the rate (6.3% vs 1.4%), and desvenlafaxine at 3.4 times the rate (1.7% vs 0.5%) of physicians receiving no target meals (all comparisons, P < .001). All tests of trend were significant (P < .001).”

A second study, also recently published in JAMA Internal Medicine, found a similar trend looking specifically at prescriptions of brand name statins in Massachusetts and industry payments to physicians (unlike the first study, this one considered all payments, not just meals).

Researchers found a particularly strong link between payments for educational training and prescribing patterns. They found an association between educational training and a 4.8% increased rate of brand-name prescribing, and concluded,

“Industry payments to physicians are associated with higher rates of prescribing brand-name statins.”

As I wrote in this previous post, it will be interesting to see if and how this kind of research, which shines a light on the politics of healthcare, sways public opinion of physicians and the healthcare system.



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