Big Pharma Gifts May Sway Doctors' Prescribing Habits, Study Suggests

Gifts, free meals, and other payments from pharmaceutical companies may influence doctors' prescribing habits, potentially leading to less appropriate and more expensive medications for patients, according to a major review by the Cochrane Collaboration. The organization, considered a gold standard in evidence-based medicine, analyzed data from 93 studies, 88 percent of which were conducted in the United States.

The review found that interactions with drug company promotion are associated with less appropriate prescribing, a higher frequency of prescriptions, and increased costs for patients. This is particularly concerning as these less appropriate drugs may offer fewer benefits, have more side effects, or be unnecessary compared to available alternatives.

"Overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive," said Dr. Lisa Bero, a medical expert at the University of Colorado Anschutz and a study author. "This is problematic for a number of reasons and it matters because it directly affects patient care."

The study examined prescriptions for various conditions, including high blood pressure, high cholesterol, depression, and opioid painkillers. While the review did not analyze direct patient harm from inappropriate prescriptions, researchers warned of significant repercussions.

Lead study author Dr. Barbara Mintzes, a professor of pharmacy at the University of Sydney, Australia, noted that many doctors believe small gifts like meals do not influence their decisions. "Doctors often think that this is trivial and doesn’t influence them, that they 'can’t be bought for the price of a sandwich,' but the data shows this is an effective marketing strategy," Mintzes said. "The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs."

The findings suggest a dose-dependent relationship: the more a doctor received from a pharmaceutical company, the more likely they were to prescribe that company's medications. The review categorized pharmaceutical promotion into advertising/education (such as sales representative visits and company-sponsored meetings) and gifts/payments (including meals, travel expenses, and speaker fees).

Both categories of promotion were linked to prescribing habits that were less appropriate, more frequent, and more costly. "Patients should be offered the most appropriate treatment for their condition, based on clinical evidence, not industry marketing," Bero stated.

She added, "The opioid crisis in North America was perhaps the most egregious example of inappropriate over-prescribing, but this was not an isolated incident. It was high-profile due to the significant harms involved, but the systems that enabled it are unfortunately considered business-as-usual within the industry."

These findings come amid estimates that up to one in 10 prescription drugs in the U.S. are overprescribed, with antibiotics having an overprescription rate of 20 to 40 percent. The review, published in Cochrane, did not name specific pharmaceutical companies involved.