ProPublica is once again trying to make a “correlation equals causation” argument between payments made to physicians and their prescribing patterns. ProPublica is arguing that an analysis they performed showed that “doctors who receive payments from the medical industry do indeed tend to prescribe drugs differently than their colleagues who don’t.”
They are arguing that doctors who received more than $5,000 from companies in 2014 had the highest brand-name prescribing percentages, giving an example that among internists who received no payments, the average brand-name prescribing rate was 20%, compared to about 30% for those who received more than $5,000.
What is interesting in the data is the absolutely high number ranging from 70-90% of generic medications both physicians who don’t work with industry and those who do work with industry. In both groups a vast majority of their prescriptions were for generic medications which generally over 20+ years from initial development. A slight increase in the use of branded drugs should be considered a good thing for patients. As it is well known that it takes many years for physician adoption to newer therapies.
However, there is no proof that industry payments sway doctors to prescribe particular drugs, or even a particular company’s drugs, just that payments are “associated with an approach to prescribing that, writ large, benefits drug companies’ bottom line.” There may be much more to the story if ProPublica found a link between payments made to physicians and the brand of drug they prescribed.
It is important to note, as laid out in more detail below, that physicians consider many factors when deciding which medications to prescribe. Some physicians treat patients for whom few, or no, generics are available; for example, doctors who treat patients with HIV/AIDS. Other physicians specialize in patients with complication conditions who have tried generic drugs with no success.
One physician that we discussed this with independently, thought it was appalling that there was no consideration of patient outcomes. If the physicians patients benefiting from the branded drugs then there should be credit given to those physicians working with industry.
According to Holly Campbell, spokeswoman for the Pharmaceutical Research and Manufacturers of America, “many factors” affect doctors’ prescribing decisions and according to a 2011 survey of physicians, more than ninety percent of physicians felt that “a great deal of their prescribing was influenced by their clinical knowledge and experience.”
Ms. Campbell believes that by working together, “biopharmaceutical companies and physicians can improve patient care, make better use of today’s medicines, and foster the development of tomorrow’s cures.” Physicians provide insights and feedback to inform companies about their medicines to improve patient care and patient health.
By meeting with industry professionals, doctors get a chance to better understand the drugs that exist, the outcomes, and any side effects. Dr. Amer Syed of Jersey City, NJ, said that he does look at the quality of medication and the benefits patients get from taking the medicine before deciding what to prescribe, stating that his “whole vision of practice is to keep the patients out of the hospital.”
Methodology
ProPublica examined Medicare Part D prescription data and pharmaceutical and medical device company payment data (found under Open Payments) to measure any relationship between industry payments and brand-name prescribing.
Interestingly, when ProPublica broke down the data by payment type, they found that physicians who received speaking payments had higher rates of brand-name prescribing than those who received other types of payments, and that physicians whose only payments were for meals had lower rates of brand prescribing than those who received other payments. This may speak to the idea that physicians who prescribe the same drug over and over again do so because they are comfortable with it, they know the results and the side effects, and since they know the drug so well, the company asks them to speak for them.
There is a huge “but” with the data cited to by ProPublica. The data does not consider whether branded drugs, for the indications prescribed, are superior to generic medications (or combinations of generic drugs), nor whether patient outcomes were different. Data that confirms safety and efficacy are much more likely to describe branded products than they are generics.
We are big proponents, however, of giving credit where credit is due. In this case, ProPublica did a nice job describing the circular relationship between companies and doctors. They published a quote by Dr. Kim Allan Williams, Sr., the president of the American College of Cardiology, who stated the more physicians learn and understand a new drug’s “differentiating characteristics,” the more likely they are to prescribe it, and the more they prescribe it, the more likely they are to be selected as speakers and consultants for the company. According to Dr. Williams, “that dovetails with improving your practice, and yes, you are getting paid to do it.”
Dr. Williams also explained that new drugs are somewhat responsible for the significant decrease in cardiovascular mortality in the past three decades, and that the relationship between doctors and companies in cardiology may be driving that progress.