Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Physicians, Industry Payments for Food and Beverages, and Drug Prescribing

Physicians, Industry Payments for Food and Beverages, and Drug Prescribing In 2015, the pharmaceutical industry and other health care companies reported to the Centers for Medicare & Medicaid Services through the Open Payments program a total of $235 million in food and beverage payments to physicians, accounting for approximately 12% of general payments.1 General payments include royalties and licenses, consulting, services other than consulting, travel and lodging, and serving as faculty in accredited and unaccredited education programs. There are about 850 000 active physicians in the United States. Of 616 567 physicians in the United States with any type of general payment in 2015, 589 042 (95.5%) received food and beverage payments, with a total mean value per physician of $400 and a median value of $138.1 Although the median value of each food and beverage payment is modest, these are by far the most frequent types of gifts and payments that physicians receive from industry, apparently now supplanting the branded black bags, pens, mugs, and other tchotchkes of yore.2 Individual physicians may note that even though they attended an industry-sponsored educational or promotional event where food and beverages were provided, they did not eat or drink anything; nonetheless, anyone who registered at the event is considered to have received a payment, with the per-physician amount determined by dividing the total that the sponsor spent on food and beverages by the number of attendees. Providing hundreds of millions of dollars of industry payments to physicians for food and beverages each year is not a charitable act; like other investor-owned businesses, pharmaceutical companies seek to maximize their profits, and they provide meals with the expectations of good returns.3 Without the provision of food and beverages, it is likely that fewer physicians would attend industry events and listen to presentations by academic experts, pharmaceutical company employees, or other speakers paid for by industry. For years, the evidence has suggested that even small gifts can influence physicians’ behavior, create a mindset of entitlement, and help to promote allegiance to companies and their products.2,4,5 Recently, with the availability of Open Payments data6 and research made possible by these data, the evidence has become stronger. Using Open Payments data, a 2016 study found that receipt of industry-sponsored meals, even just a single meal, was associated with an increase in the rate of prescribing the brand-name drug that was being promoted.7 DeJong and colleagues7 found that physicians who received a single meal (mean value of $12 to $18 per meal) promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins, nebivolol over other β-blockers, olmesartan over other angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, and desvenlafaxine over other selective serotonin and serotonin-norepinephrine reuptake inhibitors. With receipt of additional meals and of meals costing more than $20, there were higher relative prescribing rates. For example, in unadjusted analyses, “[p]hysicians receiving meals related to target drugs on 4 or more days prescribed rosuvastatin at 1.8 times the rate (15.2% vs 8.3%), nebivolol at 5.4 times the rate (16.7% vs 3.1%), olmesartan at 4.5 times the rate (6.3% vs 1.4%), and desvenlafaxine at 3.4 times the rate (1.7% vs 0.5%) of physicians receiving no target meals (all comparisons, P < .001).”7 The drugs were chosen for study because they were the most-prescribed brand-name drug in each of their drug categories in Medicare Part D in 2013, with what the authors characterized as “limited, mixed, or contrary evidence about the superiority of these 4 drugs over generic alternatives.”7 A separate analysis of Open Payments data by Ornstein and colleagues8 found that “[d]octors who got money from device and drug makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t,”8 and “the more money they receive, on average, the more brand-name medications they prescribe.”8 The mean prescribing rates of brand-name drugs among family medicine physicians, internists, cardiologists, psychiatrists, and ophthalmologists were highest among those who received other types of payments (such as speaking payments, either alone or in combination with meals) than those whose only industry payments were for meals. Nonetheless, physicians who received only meals still had significantly higher rates of prescribing brand-name drugs than physicians who received no industry payments.9 A limitation of both studies is that their findings represent associations between industry payments for food and beverages and physician prescribing behavior, not cause-and-effect relationships. Some of those attending industry events may already prefer a company’s drug and are seeking additional information from the company that markets it. Some physicians make a point of avoiding promotional events. Those in attendance are a skewed sample of prescribers. Focusing on such limitations, however, begs a broader question: is there any need to prove a causal relationship between industry payments to physicians and the prescribing of brand-name medications? First, industry-sponsored meals and other outright gifts may be legal, but are there any reasons for physicians to either expect or accept them? Second, in this situation, perceptions of conflict of interest are more important than discussing whether there is an actual conflict of interest, and the clear perception is that companies are using the provision of food and beverages to increase attendance at promotional events and to drive sales. Third, part of the privilege of caring for patients is to be mindful of their finances as well as their health. In 2015, spending on prescription drugs alone in the United States was approximately $1000 per person. For situations in which less expensive and similarly effective alternative medications are available, physicians should be prescribing these alternatives, not more expensive choices. Fourth, even when patients have prescription drug insurance or may be eligible for rebates or other discounts, unwarranted prescribing of more expensive medications shifts costs to insurers, states, the federal government, and society as a whole and makes needed health care less affordable for everyone. There are complex issues and trade-offs with regard to conflict of interest in medicine. Gifts, which in 2017 are primarily industry-sponsored meals, however, are not one of these. The American Medical Association’s Code of Medical Ethics is clear that “[g]ifts to physicians from industry create conditions that carry the risk of subtly biasing—or being perceived to bias—professional judgment in the care of patients.”10 Physicians have to ask why they are accepting this industry largesse. Each year, $235 million would pay for considerable needed care for patients who cannot afford it or essential clinical research. Instead of dining on meals from industry, physicians should be advocating for drug and device manufacturers to spend less on promoting their products and more on independent bona fide research on safety, effectiveness, and affordability. Patients and the health care system deserve no less. Back to top Article Information Corresponding Author: Robert Steinbrook, MD, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, I-456 SHM, PO Box 208008, New Haven, CT 06520 (robert.steinbrook@yale.edu). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Winter A, Phillips A. Payments from drug and device manufacturers to physicians and teaching hospitals in 2015. http://www.medpac.gov/docs/default-source/meeting-materials/payments-from-drug-and-device-manufacturers_nov-2016_public.pdf?sfvrsn=0. November 3, 2016. Accessed February 21, 2017. 2. Steinbrook R. Physician-industry relations—will fewer gifts make a difference? N Engl J Med. 2009;360(6):557-559.PubMedGoogle ScholarCrossref 3. Steinbrook R. Industry payments to physicians and prescribing of brand-name drugs. JAMA Intern Med. 2016;176(8):1123.PubMedGoogle ScholarCrossref 4. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283(3):373-380.PubMedGoogle ScholarCrossref 5. Brennan TA, Rothman DJ, Blank L, et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006;295(4):429-433.PubMedGoogle ScholarCrossref 6. Centers for Medicare & Medicaid Services. Open Payments. https://www.cms.gov/openpayments/. Accessed February 22, 2017. 7. DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med. 2016;176(8):1114-10.PubMedGoogle ScholarCrossref 8. Ornstein C, Jones RG, Tigas M. Now there’s proof: docs who get company cash tend to prescribe more brand-name meds. https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs. March 17, 2016. Accessed February 21, 2017. 9. Jones RG, Ornstein C. Matching industry payments to Medicare prescribing patterns: an analysis. https://static.propublica.org/projects/d4d/20160317-matching-industry-payments.pdf?22. March 2016. Accessed February 22, 2017. 10. American Medical Association. Chapter 9: opinions on professional self-regulation. In: Code of Medical Ethics. Chicago, IL: American Medical Association; 2016. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-9.pdf. Accessed February 21, 2017. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Physicians, Industry Payments for Food and Beverages, and Drug Prescribing

JAMA , Volume 317 (17) – May 2, 2017

Loading next page...
 
/lp/american-medical-association/physicians-industry-payments-for-food-and-beverages-and-drug-qy92zl1H3O

References (5)

Publisher
American Medical Association
Copyright
Copyright © 2017 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2017.2477
pmid
28464155
Publisher site
See Article on Publisher Site

Abstract

In 2015, the pharmaceutical industry and other health care companies reported to the Centers for Medicare & Medicaid Services through the Open Payments program a total of $235 million in food and beverage payments to physicians, accounting for approximately 12% of general payments.1 General payments include royalties and licenses, consulting, services other than consulting, travel and lodging, and serving as faculty in accredited and unaccredited education programs. There are about 850 000 active physicians in the United States. Of 616 567 physicians in the United States with any type of general payment in 2015, 589 042 (95.5%) received food and beverage payments, with a total mean value per physician of $400 and a median value of $138.1 Although the median value of each food and beverage payment is modest, these are by far the most frequent types of gifts and payments that physicians receive from industry, apparently now supplanting the branded black bags, pens, mugs, and other tchotchkes of yore.2 Individual physicians may note that even though they attended an industry-sponsored educational or promotional event where food and beverages were provided, they did not eat or drink anything; nonetheless, anyone who registered at the event is considered to have received a payment, with the per-physician amount determined by dividing the total that the sponsor spent on food and beverages by the number of attendees. Providing hundreds of millions of dollars of industry payments to physicians for food and beverages each year is not a charitable act; like other investor-owned businesses, pharmaceutical companies seek to maximize their profits, and they provide meals with the expectations of good returns.3 Without the provision of food and beverages, it is likely that fewer physicians would attend industry events and listen to presentations by academic experts, pharmaceutical company employees, or other speakers paid for by industry. For years, the evidence has suggested that even small gifts can influence physicians’ behavior, create a mindset of entitlement, and help to promote allegiance to companies and their products.2,4,5 Recently, with the availability of Open Payments data6 and research made possible by these data, the evidence has become stronger. Using Open Payments data, a 2016 study found that receipt of industry-sponsored meals, even just a single meal, was associated with an increase in the rate of prescribing the brand-name drug that was being promoted.7 DeJong and colleagues7 found that physicians who received a single meal (mean value of $12 to $18 per meal) promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins, nebivolol over other β-blockers, olmesartan over other angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, and desvenlafaxine over other selective serotonin and serotonin-norepinephrine reuptake inhibitors. With receipt of additional meals and of meals costing more than $20, there were higher relative prescribing rates. For example, in unadjusted analyses, “[p]hysicians receiving meals related to target drugs on 4 or more days prescribed rosuvastatin at 1.8 times the rate (15.2% vs 8.3%), nebivolol at 5.4 times the rate (16.7% vs 3.1%), olmesartan at 4.5 times the rate (6.3% vs 1.4%), and desvenlafaxine at 3.4 times the rate (1.7% vs 0.5%) of physicians receiving no target meals (all comparisons, P < .001).”7 The drugs were chosen for study because they were the most-prescribed brand-name drug in each of their drug categories in Medicare Part D in 2013, with what the authors characterized as “limited, mixed, or contrary evidence about the superiority of these 4 drugs over generic alternatives.”7 A separate analysis of Open Payments data by Ornstein and colleagues8 found that “[d]octors who got money from device and drug makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t,”8 and “the more money they receive, on average, the more brand-name medications they prescribe.”8 The mean prescribing rates of brand-name drugs among family medicine physicians, internists, cardiologists, psychiatrists, and ophthalmologists were highest among those who received other types of payments (such as speaking payments, either alone or in combination with meals) than those whose only industry payments were for meals. Nonetheless, physicians who received only meals still had significantly higher rates of prescribing brand-name drugs than physicians who received no industry payments.9 A limitation of both studies is that their findings represent associations between industry payments for food and beverages and physician prescribing behavior, not cause-and-effect relationships. Some of those attending industry events may already prefer a company’s drug and are seeking additional information from the company that markets it. Some physicians make a point of avoiding promotional events. Those in attendance are a skewed sample of prescribers. Focusing on such limitations, however, begs a broader question: is there any need to prove a causal relationship between industry payments to physicians and the prescribing of brand-name medications? First, industry-sponsored meals and other outright gifts may be legal, but are there any reasons for physicians to either expect or accept them? Second, in this situation, perceptions of conflict of interest are more important than discussing whether there is an actual conflict of interest, and the clear perception is that companies are using the provision of food and beverages to increase attendance at promotional events and to drive sales. Third, part of the privilege of caring for patients is to be mindful of their finances as well as their health. In 2015, spending on prescription drugs alone in the United States was approximately $1000 per person. For situations in which less expensive and similarly effective alternative medications are available, physicians should be prescribing these alternatives, not more expensive choices. Fourth, even when patients have prescription drug insurance or may be eligible for rebates or other discounts, unwarranted prescribing of more expensive medications shifts costs to insurers, states, the federal government, and society as a whole and makes needed health care less affordable for everyone. There are complex issues and trade-offs with regard to conflict of interest in medicine. Gifts, which in 2017 are primarily industry-sponsored meals, however, are not one of these. The American Medical Association’s Code of Medical Ethics is clear that “[g]ifts to physicians from industry create conditions that carry the risk of subtly biasing—or being perceived to bias—professional judgment in the care of patients.”10 Physicians have to ask why they are accepting this industry largesse. Each year, $235 million would pay for considerable needed care for patients who cannot afford it or essential clinical research. Instead of dining on meals from industry, physicians should be advocating for drug and device manufacturers to spend less on promoting their products and more on independent bona fide research on safety, effectiveness, and affordability. Patients and the health care system deserve no less. Back to top Article Information Corresponding Author: Robert Steinbrook, MD, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, I-456 SHM, PO Box 208008, New Haven, CT 06520 (robert.steinbrook@yale.edu). Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. Winter A, Phillips A. Payments from drug and device manufacturers to physicians and teaching hospitals in 2015. http://www.medpac.gov/docs/default-source/meeting-materials/payments-from-drug-and-device-manufacturers_nov-2016_public.pdf?sfvrsn=0. November 3, 2016. Accessed February 21, 2017. 2. Steinbrook R. Physician-industry relations—will fewer gifts make a difference? N Engl J Med. 2009;360(6):557-559.PubMedGoogle ScholarCrossref 3. Steinbrook R. Industry payments to physicians and prescribing of brand-name drugs. JAMA Intern Med. 2016;176(8):1123.PubMedGoogle ScholarCrossref 4. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283(3):373-380.PubMedGoogle ScholarCrossref 5. Brennan TA, Rothman DJ, Blank L, et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006;295(4):429-433.PubMedGoogle ScholarCrossref 6. Centers for Medicare & Medicaid Services. Open Payments. https://www.cms.gov/openpayments/. Accessed February 22, 2017. 7. DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med. 2016;176(8):1114-10.PubMedGoogle ScholarCrossref 8. Ornstein C, Jones RG, Tigas M. Now there’s proof: docs who get company cash tend to prescribe more brand-name meds. https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs. March 17, 2016. Accessed February 21, 2017. 9. Jones RG, Ornstein C. Matching industry payments to Medicare prescribing patterns: an analysis. https://static.propublica.org/projects/d4d/20160317-matching-industry-payments.pdf?22. March 2016. Accessed February 22, 2017. 10. American Medical Association. Chapter 9: opinions on professional self-regulation. In: Code of Medical Ethics. Chicago, IL: American Medical Association; 2016. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-9.pdf. Accessed February 21, 2017.

Journal

JAMAAmerican Medical Association

Published: May 2, 2017

Keywords: food and beverages,prescriptions, drug

There are no references for this article.