Pharmaceutical payments, increased prescribing go hand in hand

Financial payments from pharmaceutical companies were “consistently associated with increased prescribing” across a wide range of physician specialties, drug classes and prescribing decisions, according to the authors of a recent review.

“All studies to date are unanimous: Accepting gifts from industry changes our prescribing and makes us worse doctors. Financial conflicts of interest with the drug industry are therefore contrary to our patients' interests,” Aaron P. Mitchell, MD, MPH, a medical oncologist at the Memorial Sloan Kettering Cancer Center in New York City, told Healio Primary Care.

“Collectively, we need to acknowledge that accepting money from industry is below the professional standards that we set for ourselves and quickly take action to end this practice,” he continued.

Previous studies have described how nonfinancial agreements between physicians and pharmaceutical companies affect prescribing, clinical research and clinical practice guideline and physician formulary recommendations. In their review, Mitchell and colleagues focused on 36 studies — comprising 101 analyses — that examined the effect of financial payments to physicians.

According to the researchers, 30 of the studies identified a positive association between financial payments and prescribing and six studies showed a mix of positive and null findings. “No study had only null findings,” they wrote.

Hematologists and oncologists (n = 5) and primary care physicians (n = 5) were the most common physician types to receive payment, followed by urologists (n = 4), according to the researchers. The most common drug class studied was opioids (n = 7), followed by antineoplastic (n = 3) and anti-VEGF (n = 3) medications.

Of the 101 individual analyses, 89 identified a positive association between payments and prescribing. The researchers said that payments from a pharmaceutical company were associated with increased prescribing of that company’s drug, increased prescribing costs and increased prescribing of branded drugs. Payments were also associated with the prescribing of less effective drugs and similarly effective but more expensive drugs.

“This is very concerning,” Mitchell said. “Doctors naturally gravitate toward drugs that are the most effective and best value for the money. Therefore, the manufacturers of less-effective and lower-value drugs engage in extra efforts, like personal payments to physicians, to entice us to use them. To the extent that they succeed leads to patients receiving fewer good treatments.”

Mitchell said that he hopes the findings “will help to convince additional physicians and policymakers that this is a harmful practice that should not continue.”