Doctors who take pharma industry freebies prescribe more of their benefactors' drugs

Doctors who accept pharma industry gifts (which can range from free coffees to lavish dinners to six-figure speaking fees) claim that they're not influenced by these bribes/gifts, which is possibly why doctors are taking more pharma bribes than ever.

Now, an empirical study by Propublica draws on mandatory disclosure data on pharma gifts as well as prescribing data to show that "Doctors who receive money from drugmakers related to a specific drug prescribe that drug more heavily than doctors without such financial ties."

The sample size is large. The effect size is large. The effects are consistent across multiple drugs. The size of the gift needed to change prescribing behavior is bewilderingly small.

It's not the first such study, but it's an important, empirical addition to our understanding of the problems with this practice. Obviously, the pharma industry wouldn't spend all that money if they didn't think it made a good return on their investment, but industries often spend lavishly on useless things for long periods (for example, think of all the firms that entrust hedge funds with large sums of money, despite the fact that hedge funds generally underperform relative to a simple index-tracker). It's nice to have some outside validation.

For some drugs that are household names, it was more common for prescribers to receive a payment than not to. More than half of doctors who prescribed Breo, an expensive asthma drug, to Medicare patients received payments involving the drug in 2016. This was also true for Invokana and Victoza, both of which are diabetes medications. For Linzess, nearly half of doctors who prescribed the drug had interactions with its maker.

More than one in five doctors who prescribed OxyContin under Medicare in 2016 had a promotional interaction with the drug's manufacturer, Purdue Pharma. The company did not respond to a request for comment.

"If there are physicians out there that deny that there is a relationship, they are starting to look more and more like climate deniers in the face of the growing evidence," said Aaron Kesselheim, a professor of medicine at Harvard Medical School and an expert in pharmaceutical costs and regulation. "The association is consistent across the different types of payments. It's also consistent across numerous drug specialties and drug types, across multiple different fields of medicine. And for small and large payments. It's a remarkably durable effect. No specialty is immune from this phenomenon."

Doctors Prescribe More of a Drug If They Receive Money from a Pharma Company Tied to It [Hannah Fresques/Propublica]