Hubris threatens doctors the same way it does many of society’s other technically intimidating, well-paid professions: It’s a tough club to get into, and if you’re in it, well, you must be pretty smart. (This latent trend probably played a role in Jurassic Park author Michael Crichton, who completed medical school at Harvard Medical School at age 27, preached climate change denial late in his life.)
Now, a stark warning is being issued by a team of medical researchers who reviewed 93 peer-reviewed studies examining the real-world behavior of millions of healthcare professionals who routinely prescribe medications to their patients. Contrary to what most doctors might tell themselves, free lunches, paid travel, free samples of new drugs, and other perks offered by big pharmaceutical companies have a concrete, measurable impact on the frequency with which a given medical provider subsequently prescribes a drugmaker’s products.
The new analysis, published Friday in the Cochrane Database of Systematic Reviews, documented an almost comical “dose-response” relationship, in fact, between the number of questionable prescriptions a doctor wrote for certain drugs and the number of free meals they received.
“Physicians often think it’s insignificant and unswaying, that they ‘can’t be bought for the price of a sandwich,’ but the data shows it’s an effective marketing strategy,” the journal’s lead author, pharmacy professor Barbara Mintzes, said in a statement.
Hungry, hungry Hippocrates
“It’s very common for doctors to receive free meals from companies,” according to Mintzes, who works at the University of Sydney in Australia but previously helped lead the United Nations World Health Organization’s Health Action International project. “The more free meals a doctor receives, the more likely he or she is to prescribe less appropriate or more expensive medications. »
Mintzes and his collaborators – a half-dozen researchers from medical institutions in the United States, Canada, Australia and the United Kingdom – found that this correlation held true for a range of drugs covered in the studies they reviewed. The data showed that a given pharmaceutical company’s opioid painkillers, antidepressants, and/or high blood pressure and cholesterol medications were prescribed more times, in direct proportion to the number of free meals they offered to doctors.
“This is problematic for a number of reasons and it’s important because it directly affects patient care,” study co-author Lisa Bero, a professor of internal medicine (now recently retired) at the University of Colorado Anschutz School of Medicine, said in a statement.
“These less appropriate and more expensive medications may have fewer benefits or more side effects than alternatives, or simply be unnecessary in the clinical setting.”
Best medicine
Bero, Mintzes, and their colleagues acknowledged that their systematic review did not achieve the statistical robustness required for what is called a “meta-analysis,” largely because their (still quite extensive) efforts covered such a heterogeneous set of studies. The 93 peer-reviewed studies explored the influence of “payments, gifts, or other transfers of value,” advertising and educational events targeting doctors, and free drug samples.
An overwhelming majority of studies (88%) focused on physicians in the United States, largely because the Physician Payments Sunshine Act of 2010 required pharmaceutical companies to report full details of their payments to physicians for inclusion in a publicly searchable database.
But among these disparate studies, several that addressed the impact of medical institutions’ conflict of interest policies provided cause for optimism. Two studies of 3,065 prescribers found that these policies improved the “appropriateness” of healthcare providers’ drug prescriptions, although it remains unclear whether these policies help reduce costs.
“It is encouraging that robust conflict of interest policies tend to be effective,” Mintzes noted.
Gn Health
