Research Reveals Corruption in Medication Prescription Motivations

By Kayla Matthews, HealthIT writer and technology enthusiast, Tech Blog
Twitter: @ProductiBytes

A longstanding practice in the health care sector involves pharmaceutical representatives going to hospitals to give presentations to doctors about the latest drugs. Those physicians, and sometimes any other workers who happen to be in the area, get free lunches.

The medical industry refers to such exchanges, whereby medical providers have direct contact with pharmaceutical representatives and get free things, as “detailing” or “detailing visits.”

A recent Cornell University study was the first of its kind to examine the prescribing behavior before and after receiving complimentary food. The institution’s goal was to see if these in-kind payments directly affect whether doctors prescribe certain drugs to their patients.

Previous research looked at how freebies influenced physicians’ prescription choices regarding certain drug classes or individual medications. But this study revealed the impact on all drugs.

Promotional Visits Cause Monthly Sales Upticks
Big Pharma corruption is not a new topic. So just how lucrative is it to send representatives to hospitals and other medical facilities bearing free food? It arguably makes people more willing to sit through drug presentations during their lunch hours.

More startlingly, the Cornell research indicated that pharmaceutical companies see an average 4% sales increase per month in the year following such marketing efforts. The data also revealed that every dollar spent on detailing visits caused a $ 2.64 increase in drug sales, or a 164% return on investment.

Targeting Can Make Pharmaceutical Representative Visits More Worthwhile
The study also looked at whether physicians seeing certain kinds of patients frequently impacted prescribing behavior, and whether pharmaceutical representatives could further change that behavior. The results, not surprisingly, showed that prescribing trends existed before any pharmaceutical visits happened. But, once they occurred, the prescribing likelihood for a drug went up in the following month.

The researchers also sought to learn whether pharmaceutical company goodies led to patients receiving higher-quality drugs with better efficacy rates. They chose three drug classes and agreed on endpoints related to mental health, blood pressure and cholesterol. The conclusions showed a small decrease in the quality of drugs prescribed after pharmaceutical visits. However, the drop was not large enough to have clinical significance.

No Link Found Between In-Kind Payments and Educational Benefits
An initiative to limit Big Pharma corruption requires pharmaceutical companies to disclose the amounts and types of in-kind payments made to health care providers.

The information goes into a publicly accessible database called Open Payments. As information at the Open Payments website shows, in-kind payments vary from sports tickets to branded items such as stethoscopes and USB drives. In the Cornell study, 95% of the incentives were meals. Plus, 80% of those cost less than $ 20.

The researchers focused on data from 2013 to 2015 for patients enrolled in the Medicare Part D federal program. Education is a category of in-kind payments. These can arise if pharmaceutical companies pay for textbooks related to the conditions that their drugs treat. Many of those also feature pharmaceutical branding.

Colleen Carey, the study’s lead author, said, “We took seriously the claim that there is educational value to these marketing encounters. We just don’t find any evidence for it.” Another conclusion made by the researchers was that “We do not find clear evidence that such payments are harmful to patients, only that they do not seem to be obviously helpful.”

A Complicated Problem
Pharmaceutical companies’ corruption is not a straightforward problem to solve. Detailing boosts the name recognition of new drugs. Agreeing to a free lunch while a pharmaceutical rep gives a pitch could cause them to recall a drug’s name or potential uses more readily than if that meeting never happened.

However, health care representatives are not the only people exposed to pharmaceutical advertising. The United States is the only country besides New Zealand that allows direct-to-consumer drug advertising. Consumers regularly see drug ads while watching the evening news or a favorite TV series.

Many health care facilities ban visits from pharmaceutical reps. They believe that doing so keeps doctors from getting persuaded to prescribe something a patient doesn’t need or overlooking a better option.

Arguments against that approach assert that it makes physicians less educated while also reducing access to drug samples that could prove life-saving for a patient. One possibility is that patients could choose whether they see providers that receive pharmaceutical detailing visits. But that option likely won’t reach widespread practice for a while.

Awareness Can Help Fight Big Pharma Corruption
An ideal question for people to ask themselves when reading news articles today is, “Is there another angle to the story?” Health care providers can do something similar after meetings with pharmaceutical representatives. For example, did the salesperson gush about the benefits while glossing over dangerous side effects?

Staying aware that way and encouraging collective action among colleagues could make pharmaceutical companies’ corruption less problematic.

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