In the Journals

Receipt of pharmaceutical industry-sponsored meal associated with increased prescription rate

Recent findings published in JAMA Internal Medicine showed that receipt of a pharmaceutical industry-sponsored meal was associated with increased prescription rates by physicians.

“Our findings support the importance of ongoing transparency efforts in the United States and Europe,” Colette DeJong, BA, of the Center for Healthcare Value at the University of California, San Francisco School of Medicine, and colleagues wrote. “Small payments and meals should continue to be monitored in the United States and should be incorporated into the European pharmaceutical industry’s recent transparency initiative, which requires drug companies to publicly report payments to physicians with the exception of food and drinks.”

Studies have suggested that relationships between physicians and the pharmaceutical industry are associated with greater prescribing of brand-name drugs, the researchers wrote. However, it is not known whether smaller payments, such as sponsored meals, which account for 80% of total industry payments, would also be associated.

To evaluate whether sponsored meals were associated with increased prescribing practices, DeJong and colleagues performed a cross-sectional analysis of pharmaceutical payment data from the Open Payments Program between August 1 and December 31, 2013 and physician prescribing data from Medicare Part D for all of 2013. They assessed physicians who wrote Medicare prescriptions for four drug classes: Statins; cardioselective -blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs); and selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs).

The researchers identified physicians who received sponsored meals that promoted the most-prescribed brand name for each drug class: Crestor (rosuvastatin, AstraZeneca), Bystolic (nebivolol, Allergan), Benicar (olmesartan, Daiichi-Sankyo) and Pristiq (desvenlafaxine, Pfizer), respectively. The researchers measured the prescribing rates of these drugs compared with alternatives of the same class, adjusting for specialty, practice setting, physician prescribing volume and demographic characteristics.

The study included 279,669 physicians who received 63,524 payments associated with the four target drugs. Of the payments, 95% were for meals, with an average value less than $20.

The researchers found that physicians who received a single meal that promoted the drug of interest had higher prescribing rates of rosuvastatin compared with other statins (OR = 1.18; 95% CI, 1.17-1.18), nebivolol over other -blockers (OR = 1.7; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR = 1.52; 95% CI, 1.51-1.53) and desvenlafaxine over other SSRIs and SNRIs (OR = 2.18; 95% CI, 2.13-2.23). Additional meals and meals costing more than $20 were also associated with higher prescribing rates.

In a related commentary, Robert Steinbrook, MD, in the department of internal medicine at Yale University School of Medicine, wrote that this money exchange between pharmaceutical companies and physicians should cease.

“There are inherent tensions between the profits of health care companies, the independence of physicians and the integrity of our work, and the affordability of medical care,” Steinbrook wrote. “If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off.” – by Will Offit

Disclosures: The researchers report no relevant financial disclosures.