Industry relationships influence MD prescribing behavior

Social ties to industry appear to influence physician prescribing behaviors, according to a recent study published online Jan. 7 in JAMA Internal Medicine (formerly Archives of Internal Medicine).

Eric G. Campbell, PhD, from the Department of Medicine at Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, Mass., and colleagues found that certain industry relationships appeared to increase the likelihood that a physician would accommodate a patient’s request for a brand-name drug when a generic was available.

“Prescribing brand-name drugs when generic drugs are available generates unnecessary medical expenditures, the costs of which are borne by the public in the form of higher copayments, increased health insurance costs, and higher Medicare and Medicaid expenses,” the authors wrote.

The researchers surveyed a random sample of physicians from seven specialties, including pediatricians, anesthesiologists, cardiologists, general surgeons, internal medicine physicians, family practice physicians, and psychiatrists. The authors found that 43% of physicians in practice for more than 30 years indicated that they would sometimes or often give in to patients' demands for brand-name drugs compared with 31% physicians in practice for 10 years or less (P=.001).

Internal medicine specialists were more likely than pediatricians, anesthesiologists, cardiologists, and general surgeons to accommodate patient demands (P< .001). Similarly, physicians in solo or 2-person practices were significantly more likely than those working in a hospital or medical school setting (46% vs 35%; P=.04) to yield to patient demands.

The authors identified two characteristics that appeared to be associated with whether physicians were more likely to prescribe brand-name drugs: receiving industry-sponsored food or beverages in the workplace and receiving free drug samples.

"While we cannot prove a cause-and-effect between industry marketing activities and prescribing practices, at the most basic level these data suggest that industry marketing works," Dr. Campbell said in a hospital statement. "Our results also raise serious doubts about the desirability of meeting with drug company representatives to 'stay up to date'."  

The authors note that potential interventions that could reduce this practice include having a closed health system that gives the pharmacy primary control over prescribing decisions, policies that require samples be given to a pharmacy or other appropriate office rather than the physicians, and an insurance ban on accepting food and beverages in the workplace.