A recent report published in the Annals of Internal Medicine reviewed studies that estimated the association between the receipt of income by doctors from the pharmaceutical industry and their prescribing habits to determine whether payments influence physicians’ clinical decision-making and prescribing habits.
The review encompassed thirty-six studies comprised of 101 analyses. Thirty of the thirty-six studies identified a positive association between payments and prescribing in all analyses, while the other six had a mix of positive and null findings. Of 101 individual analyses reviewed, 89 identified a positive association. Payments were associated with increased prescribing of the paying company’s drug, increased prescribing costs, and increased prescribing of branded drugs. Nine of the studies reviewed found evidence of a temporal association while 25 found evidence of a dose–response relationship.
The study found the main forms of payment were consulting and speaker fees, travel and hotel expenses, and dining out. In some cases, the incentives were enough to be the main source of a physician’s income, according to the report, which reviewed results from 36 studies. The report found that generally speaking, 67% of doctors received some kind of payment from the pharmaceutical industry between 2015 and 2017, and when the review was narrowed down to specialists – including those in the fields of medical oncology, orthopedic surgery, urology, and others – the proportion increased to more than 80% of those doctors receiving some form of payment from the pharmaceutical industry.
“Our results support the conclusion that personal payments from industry reduce physicians’ ability to make independent therapeutic decisions and that they may be harmful to patients,” the authors said. “The medical community must change its historical opposition to reform and call for an end to such payments.”
It is worth pointing out, however, that the report acknowledged possible limitations, including that the design was observational, twenty-one of the thirty-six studies had serious risk of bias, and a publication bias was possible. Additionally, there is never any discussion in these types of papers about whether the increase in prescriptions helps patients live longer or improves their quality of life.