Yet another study has been published by the BMJ, purporting to link payments by manufacturers of pharmaceuticals to physicians, asserting that such payments are “associated with greater regional prescribing of marketed drugs among Medicare Part D beneficiaries.” The study, led by Dr. William Fleischman, concluded that “payments made to specialists and payments for speaker and consulting fees were predominantly associated with greater regional prescribing of marketed drugs than payments to non-specialists or payments for food and beverages, gifts, or educational materials.”
Importantly, the study also notes that “As a cross sectional, ecological study, we cannot prove causation between payments to physicians and increased prescribing” and that “Furthermore, our findings should be interpreted only at the regional level.” However, it is more likely than not that many anti-industry people will use this article as further ammo and “proof” that payments to physicians are detrimental to patients.
This study focused on oral anticoagulants, or blood thinners, and non-insulin drugs used to treat diabetes. The study found that when a pharmaceutical company spends $13 on a physician, that company will later see ninety-four additional days of prescriptions for brand-name anticoagulants and an additional 107 days of prescribing brand-name drugs to treat diabetes.
The study examined nearly 46 million prescriptions to roughly 10.5 million Medicare recipients, using Open Payments and Medicare Part D prescribing data for two classes of commonly prescribed, commonly marketed drugs: oral anticoagulants and non-insulin diabetes drugs, overall and stratified by physician and payment type. The prescriptions were written by 624,000 doctors for the last five months of 2013 and the full year 2014. Specialists as defined by the study included cardiologists and hematologists for the anticoagulants, and endocrinologists for the diabetes drugs.
Among 306 hospital referral regions, there were 977,407 payments to physicians totaling roughly $61 million related to oral anticoagulants, and 1,787,884 payments totaling just over $108 million related to non-insulin diabetes drugs. Payments made to specialists were associated with greater prescribing of marketed drugs than payments to non-specialists.
Commentary from the Study’s Lead Author
Dr. Will Fleischman, lead author of the study and clinical assistant professor in the department of emergency medicine at the University of Maryland School of Medicine, notes that a typical habit is for a pharmaceutical sales representative to take a doctor out to lunch. Later, that doctor may prescribe a medication to a patient for about a three-month period.
Fleischman is careful to couch his allegations in a safety net, however, noting that, “We’re not saying that the payment caused the prescription but that it’s tied to the prescription. For each payment in a region, they could expect three months of a medication being prescribed over a generic medication.”
Additional Comments by Study Authors
As is typically the case with studies that purport to link industry payment to prescribing habits of physicians, the authors of this study also issued a disclaimer of sorts, noting that “Patients may benefit from physicians being made aware of newly approved, effective treatments that may have fewer adverse effects, reduce the need for monitoring tests, or improve adherence.”