Do Free Meals From Pharma Reps Affect Doctors' Prescribing Habits?

By Paul Gaita 08/03/18

A new paper examined prescribing numbers and marketing efforts by two pharmaceutical companies to determine if free meals made an impact.

doctor having lunch

Cardiologists who were taken out for a meal by sales representatives from two major drug manufacturers were 73% more likely to prescribe medication from those companies, even if equivalent, lower-costing generic drugs were available.

Those are the findings suggested by a new paper from the National Bureau of Economic Research (NBER), which also alleged that while an increase in prescribing certain drugs can be a positive for patients that use them, it can also take a toll on consumers by pushing more expensive drugs over cheaper alternatives; the paper's authors estimated that the total cost was $190 million.

The paper also suggested that such marketing techniques for doctors should be eliminated altogether, as several states and health care systems have already done

The paper looked at prescribing numbers and marketing efforts by two pharmaceutical companies, Pfizer and AstraZeneca—which make the cholesterol-lowering drugs Lipitor and Crestor, respectively—between the years 2011 and 2012. Meal payments were made the focus because they were the most popular form of courting doctors, and made for the majority of non-research payments during that time period.

As MarketWatch reporter Emma Court noted, meal payments are, "by their very nature, designed to be 'pure persuasion,' as opposed to payments for consulting or speaking."

Meal payments were valued at less than $150.

As for the nature of the discussion, the paper's authors opined that it was "very likely that statins"—drugs used to reduce fat levels in blood—"were the focus of any drug-related discussions," since Lipitor and Crestor comprised the majority of both companies' sales to cardiologists. 

The researchers found that when the two companies' sales representatives paid for meals when meeting with cardiologists, those doctors were 73% more likely to prescribe Lipitor or Crestor to their patients. It did not appear to matter what sort of meal it was; as the report's authors noted, "it appears that the effect is driven by the receipt of any meal, regardless of its value." 

The information disseminated by the companies' sales representatives also did not impact the doctors' decisions; as Court wrote, both drugs had been available for nearly a decade (15 years, in the case of Lipitor), which meant that new information about either medication was unlikely to be provided at these lunch meetings, and lower-priced generic equivalents for both drugs were widely available.

Plying medical professionals with gifts, which ranged from simple meals to lucrative speaking engagements and consulting work, has been a regular sales and marketing practice for pharmaceutical companies.

But with studies like the NBER report suggesting that prescription rates rise and clinical treatment can be influenced after such treatment—which in turn can have a negative impact on health care costs and patient health—health industry observers and policymakers have turned to legislation that requires pharmaceutical companies to report all payments made to doctors, or ban such gestures altogether.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.