Welcome to the latest installment of my water is wet series of posts...well it isn't really a series but I've been made fun of in the past for discussing articles which examine topics of which the answers are "obvious." Todays post will not differ from that trend in the slightest! I say this because I am quite sure you are already aware of the answer to the question posted by the title! Or are you? Yes, you probably are :)
Nevertheless, today we will be discussing an article recently published in the jounal PLoS One titled "Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia." In this succinctly titled article the authors were trying to provide some quantifiable data looking at whether or not gifts from pharmaceuticals had an effect on the way physicians prescribe medications to their patients.
Water Is Wet.. I mean Giving Gifts Affects Human Behavior
This isn't exactly an earth shattering idea, I mean... why do people give gifts in the first place? It's usually to get something in return, even if that something is just good will from the person gifted the item. So, it shouldn't come as much of a surprise to anyone that when a pharmaceutical company gives some fancy swag to a doctor (or buys them lunch, dinner, breakfast, a coffee... really anything) its going to change how the doctor views that particular company, as well as how the doctor thinks about the product they are selling. [2]
The whole concept revolving around this conflict of interest of interacting with pharmaceutical companies and the effect it has on how doctors prescribe medication has been studied quite a bit in reality. [3], [4].
Ask physicians if they think other physicians are affected by gifts from pharmaceuticals and 77% of them will tell you yes! [5]. Ask a physician if they think it effects them... well they will tell you that it doesn't (and they will be wrong!) Further still, many believe that smaller gifts don't affect any physicians behavior at all. [6] This is just an illustration of peoples inherent inability to identify their own bias at times. I am sure I fall prey to this in many circumstances as well, so its hard to fault the doctors for thinking they are not themselves a part of the problem.
What Did The Researchers In This Publication Look At?
The authors of this article were studying Medicare claims made by physicians and their patients in Washington D.C., they used these claims and the information available therein to quantify the relative amounts of what drugs were prescribed, the total amount of money that the prescriptions cost, and what the ratio of name brand and generic drug prescriptions were. They then correlated this data with pharmaceutical marketing data available through either Washington D.C's Department of Health AccessRx program, which requires pharmaceuticals to disclose their marketing and promotional activities to doctors in the D.C. area, or another database called Open Payments.
What Did They Find?
Not shocking to anyone, they found that the overall cost of the claims filed by physicians in a variety of specializations were higher for those who had received gifts from pharmaceutical companies (blue) then for those who had not received gifts (red). The authors report that on average a claim filed to medicare for medical care by a physician who had not received a gift was $85, while claims filed for care by physicians who had recently received pharma swag were $135! An increase of $50 per claim on average! That's quite a steep increase!
Beyond this the authors also showed that the more expensive the gifts were that the doctors received (ooohh some over $500) the more expensive the claims ended up being, and also the more likely a doctor was to prescribe a name brand medication over that of a generic one.
What we can take away from this data is that there is a correlation between doctors receiving gifts and more expensive healthcare costs.
Some Other Thoughts From The Authors Discussion Of The Data
You might ask, how do I know that the more expensive gifts are not just being targeted to doctors who prescribe the most name brand drugs, rather than the prescribing of the drugs resulting from receiving the gifts. The authors concede this point, we don't. However the end result from this line of thinking doesn't matter, because the gifts in this case are still being given to reinforce the behavior of those doctors and keep them writing more expensive prescriptions.
So next time you go to your physician and they prescribe you the name brand version of a medication, is that because it truly works better than the generic (this is sometimes the case) or because they recently had a fancy dinner? As someone who works for a pharmaceutical company that REFUSES to engage in this sort of promotional material (likely to the tune of smaller profits, but it's worth it to not be shady) I recognize that this sort of promotional behavior is not good for patients and not good for healthcare in general.
If only more companies felt that way.
At least better educating doctors on this phenomenon is a start in the right direction!
Sources
Text Sources
- http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186060
- https://www.ncbi.nlm.nih.gov/pubmed/27322350
- https://www.ncbi.nlm.nih.gov/pubmed/8309031
- https://www.ncbi.nlm.nih.gov/pubmed/10647801
- https://www.ncbi.nlm.nih.gov/pubmed/2398609
- https://jamanetwork.com/journals/jama/article-abstract/196871
Image Sources
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