Do Free Meals Really Influence Which Drug Brands Physicians Prescribe?

The international controversy continues: Do drug company’s “bribe” doctors to prescribe their brands? Recent headlines insist that is the case, basing the conclusions of a recent JAMA study. NPR’s headline read, “Even A Small Meal For A Doctor Can Tip The Balance For A Brand-Name Drug.” The WSJ declared, “Even Cheap Meals Influence Doctors’ Drug Prescriptions, Study Suggests,” while the NYT wrote, “Drug Company Lunches Have Big Payoffs.”

It’s not like this is “new” news. Pharma has been fending off these attacks for years, but this is the first study specifically focused on meals and their relationship to prescription rate hikes. So the JAMA study re-ignited the controversy, analyzing information collected on 279,669 doctors who received 63,524 payments from drug companies in 2013 based on data from the 2013 Medicare Part D Open Payments data, which is mandated by the Sunshine Act. The study targeted specific drugs in four categories: Cholesterol lowering statins, two types of blood pressure drugs, and antidepressants. According to JAMA, recent data analysis performed from August 20, 2015 to December 15, 2015, noted that “industry-sponsored meals were associated with an increased rate of prescribing the brand-name medication that was being promoted.”

Most meals provided for physicians at industry-sponsored meal meetings averaged between $12 and $18. JAMA found that a single meal prompted an uptick in physician prescriptions for brand medication, some from 52% to 70% based on the drug category—and the more meals doctors received, the more likely they were to increasingly prescribe the medication promoted.

But importantly, the survey also noted that the findings represent an association in this context, not a cause and effect relationship—in other words, no causal proof.

Sales and marketing expert and Principal at ZS Associates, Bill Coyle, took issue, noting discrepancies in how the study was conducted. Among them, the study does not control for the fact that meals provided by pharma representatives are almost always provided in tandem with other activities, such as rep visits, peer-to-peer meetings and giving samples to help patients, factors that, when left out, constitute a gross exaggeration in the correlation between meals and prescriptions.

Also, the data chosen for the study is, overall, an inaccurate representation of the industry. The four drugs studied account for, on average, 4% of prescription volumes in their markets. Further, the data only accounts for the 6% of physicians who have ever received a meal. With such a narrowed focus, according to Coyle, the results of this study may not be as widespread as originally claimed.

Finally, the suggestion that pharma spending on meals hinders research and development of new drugs is unfounded. “The industry spends about $50 billion annually on new treatment and cure R&D. It spends less than 0.5% of that amount on ‘lunch and learns’ with doctors.”

John Kamp, Executive Director, Coalition for Healthcare Communications, also makes an incisive observation: “Information is power. The more information prescribers obtain, the more they are likely to use a drug safely and effectively. Dinner meetings are regulated by the FDA to ensure the information is consistent with the basic information about the drug and is not false or misleading in any way. The fact that the doctors have dinner as part of the process, does not change the facts of the presentation in any way. Education informs effective prescribing.”

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