Twenty Bucks Says Your Doctor’s Prescription Pad Is for Sale

$20 billA primary care physician in the United States receives an average, total, annual compensation of roughly $195,000, and likely will take in more than $6.5 million over a lifetime of practice. Ask most Americans and that’s a respectable, and deserved, income.

Which makes it all the more eyebrow-raising that a leading journal,  JAMA Internal Medicine, published a study that finds that Big Pharma can sway doctors’ drug prescribing practices for about the cost of a large pizza and a few sodas, roughly $20.

Just to be clear, this scrutiny involved more than 275,000 MDs, and more than 65,000 payments over four medications. The research doesn’t purport to demonstrate cause-and-effect but shows a troubling correlation.

As the Washington Post summarized:

Doctors who ate a single meal on a drug company’s tab had a higher likelihood of writing a prescription for the name-brand drug that was being promoted instead of equivalent drugs that were cheaper. … And the more meals — or the more expensive the meals — the greater the rate of prescribing the pitched drug.

Researchers scrutinized a big federal database that records meals, travels, speaking fees, and other financial relationships between docs and Big Pharma, then they also looked at a few commonly prescribed drugs for which there were costly though not necessarily more effective options.

Big Pharma spokespeople have criticized the study, noting that it could be conducted only because of the transparency about even small amounts of money that change hands between the industry and MDs when medications get promoted. Health experts expressed surprise and disappointment that doctors could be so easily swayed on so critical an issue as getting the most effective, least costly, and most widely available drug for their patients.

The researchers noted that physicians have taken considerable fire over whether Big Pharma sways key health care decisions with samples, ads, trips, and other marketing methods. I’ve written recently about how Big Soda has tried to sway pediatricians in Latin America with office swag, branded giveaways like prescription pads and “diplomas” for good-behaving kids.

Experts quoted by the Post noted that some simpler human traits may drive doctors’ decisions on drugs: the need to be liked. They said that MDs would be insulted if offered $20 in cash, in hopes of getting them to order for their patients a costlier med. But if Big Pharma salesmen can persuade doctors to engage in a social setting, including a cup of coffee and a doughnut, or a quick sandwich in the cafeteria, MDs react in human fashion. They want to please and to be liked, so seemingly small decisions about meds get made on a relationship- rather than fact-based bases.

That, of course, is a generous view of what also quickly can race down a slippery slope to become a big source of health care corruption, quid pro quo or even criminal conduct that jacks up costs and endangers patients.

Indeed, a federal task force that I have written about before, has announced another big, nationwide series of busts with charges against more than 300 people, including 61 doctors, nurses, and other licensed medical personnel, accused of $900 million in false Medicare billing. The fraudulent activities include billing for drugs never purchased or given to patients.

As for the more common and ordinary issue of Big Pharma influencing doctors, I know it can be difficult to prove direct-line motivation between MDs prescribing and their receiving office merchandise, speaking invitations, samples, and the like.

But I also credit news organizations like ProPublica, the online, Pulitzer Prize-winning investigative site, for building data and a case around how troubling an issue this is. It also ends up in the civil justice system, where lawsuits sometimes can be needed to demonstrate the patient harms when some bad doctors let their financial interests override their duty to provide good care.

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