Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

Abstract

IMPORTANCE The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available. OBJECTIVE To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013. Participants were physicians who wrote Medicare prescriptions in any of 4 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). We identified physicians who received industry-sponsored meals promoting the most-prescribed brand-name drug in each class (rosuvastatin, nebivolol, olmesartan, and desvenlafaxine, respectively). Data analysis was performed from August 20, 2015, to December 15, 2015. EXPOSURES Receipt of an industry-sponsored meal promoting the drug of interest. MAIN OUTCOMES AND MEASURES Prescribing rates of promoted drugs compared with alternatives in the same class, after adjustment for physician prescribing volume, demographic characteristics, specialty, and practice setting. RESULTS A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates. CONCLUSIONS AND RELEVANCE Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.

Ethical drug marketing criteria for the 21st century

“…Analyses of internal drug company documents,31 testimonies from whistle blowers,38 and transparency databases39 have revealed new marketing strategies that are not sufficiently covered by the 1988 WHO ethical criteria. Drug companies are using health professionals in new ways, including honorary authorships of scientific papers, excessive financial remuneration for speaking at so called educational events, and generous stipends for advisory positions or other nominal services 31.…”

Opioid Prescribing: How Well Do We Know Ourselves?

“…For example, just 8 % of physicians surveyed believed that they were susceptible to promotional items such as pharmaceutical branded pens [19]. However, the receipt of minimal gifts, valued at less than 20 dollars, was associated with an increased rate of prescribing the promoted brand-name medication relative to alternatives within the same drug class [20]. When the effect of subtle exposures to branded pharmaceutical promotional items was tested experimentally in medical students, pharmaceutical marketing was found to influence implicit attitudes of brand preference.…”

Industry payments to physician journal editors

“…For example, among prescribing physicians, a single meal promoting a brand-name medication results in an increased rate of prescribing that medication. 22 Readers will have to reach their own conclusions whether a large number of small payments to editors making decisions, or a small number of very large ones, is most likely to introduce bias, but it seems inescapable that bias would be introduced to some degree, and that currently a reader cannot know how much or by whom. 23 Our study had limitations.…”