Most of us think we’re immune to gifts, but prescription patterns say otherwise
STUDY: Fickweiler F et al, BMJ Open 2017;7:e016408
STUDY TYPE: Systematic review
FUNDING: Independent
Background
The pharmaceutical industry spends tens of billions a year on sales reps. They wouldn’t pay if it didn’t bring results.
The Study
- 49 studies published between 1992 and 2016, covering physicians, residents, and trainees worldwide
- Cross-sectional surveys, cohort studies, and a few randomized trials
- Compared physicians with industry contact to those without, tracking attitudes, prescribing, and formulary requests
Results
Doctors who had more contact with sales reps prescribed more of that company’s drug and requested it more often for the hospital formulary. Industry-sponsored meals raised the odds of prescribing the promoted brand. In one study, physicians who attended an all-expenses-paid conference tripled their prescribing of the sponsor’s drugs, yet insisted the trip hadn’t swayed them. Attending industry-funded continuing education also tilted prescribing toward branded drugs, while doctors who skipped it prescribed more generics.
Doctors denied this influence across many studies. In one, 61% of residents said gifts didn’t affect their own prescribing, but only 16% extended that same trust to their colleagues.
Junior trainees received twice the free samples that senior physicians did, and contact peaked early in training, when habits are still forming.
Limitations
The trials were not randomized, so it is possible that physicians who are more inclined toward the branded drug seek out industry interactions more. The authors report on three randomized trials, but none of those tested the hypothesis (eg, one showed residents who were randomized to education on industry influence were less likely to interact with it).
Practice Implications
- It is possible, and perhaps beneficial, to run a practice without meeting drug reps.
- Read the literature on your own, and choose coupons on the pharmaceutical website over samples.
- Today, all gifts are reported, even books and meals. Check your data at the Centers for Medicare and Medicaid Services Open Payments.
