Drug companies don’t need to give doctors thousands of dollars in kickbacks to sway them to prescribe their medications and implant their devices. A new study published online in JAMA Internal Medicine shows that doctors who received a free meal from a pharmaceutical company were more likely to prescribe the drug the company was promoting than doctors who received no such meals.
The findings of the study were based on an analysis of U.S. government data which tracked both industry payments to doctors and physicians’ from ‘Medicare Part D’ and prescriptions of drugs. Researchers analyzed payments and prescriptions in 2013 associated with 3 brand-name cardiovascular drugs and 1 antidepressant, The Wall Street Journal reports. All of the drugs had lower-cost alternatives.
Drug companies regularly shower doctors with not only free food, but all kinds of trinkets, cash, and all-expenses paid vacations to exotic locations. In 2008, so many complaints had been lodged about the industry’s efforts to influence doctors with gifts that the industry voluntarily gave up a lot of the items they offered to doctors, ranging from pens bearing a company’s name, to expensive equipment. However, attractive-looking drug reps still hand out gifts to doctors, even if it’s in the form of a pizza.
Just 1 Meal is Enough to Sway
The study found that doctors who received just 1 meal, which often costs less than $20 on average, were up to 2 times more likely to prescribe a brand-name drug promoted by a company than a cheaper generic alternative, compared with physicians who did not accept a meal.
The team wrote:
“Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug.
Although voluntary guidelines from the American Medical Association and Pharmaceutical Research and Manufacturers of America allow meals and gifts to physicians of up to $100 in value, our findings indicate that even payments of less than $20 are associated with different prescribing patterns.
Small payments and meals should continue to be monitored in the United States.” 
Doctors who received multiple free meals were as much as 3 times more likely to prescribe promoted brand-name drugs.
Study author Colette DeJong, a research fellow at University of California San Francisco’s (UCSF) Center for Healthcare Value, told HealthDay News:
“To my surprise, tiny, tiny payments are associated with big differences in prescribing.”
Additional meals – and pricier ones – were linked with even higher prescribing rates of promotional drugs. DeJong added:
“So whether you get zero, one, two, three or four meals has a step-wise increase in the prescribing of the brand-name drug that’s being promoted, and that has huge implications for Medicare and huge implications for patients.”
The American Medical Association and Pharmaceutical Research and Manufacturers of America (PhRMA) has established guidelines which allow companies to give doctors meals and gifts worth up to $100.
Doctors Feel in Debt After Receiving Gifts
Senior study author Dr. Adams Dudley, director of UCSF’s Center for Healthcare Value, said the low-cost meals offered by pharmaceutical companies give doctors a sense of indebtedness. He explained that it’s not the value of the gift driving doctors’ prescribing patterns; it’s “feeling like you owe the drug rep something.”
The majority of Medicare beneficiaries are in prescription drug plans where the median copay is $1 for generics, and $40 to $80 for brand-name drugs. It’s easy to see how financially-devastating that could be for Medicare patients who take multiple medications.
PhRMA spokeswoman Holly Campbell found the findings to be biased. She told HealthDay News:
“This study cherry-picks physician prescribing data for a subset of medicines to advance a false narrative.”
It’s common for drug companies to engage with doctors to share information concerning drug safety and efficacy, Campbell said, as well as new indications for approved medicines and potential side effects.
The study’s authors say the results do not prove a cause-and-effect relationship. It could be that doctors attend industry events where information is provided on drugs they already prefer.
 NBC News
Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. She lives in Pennsylvania with her husband and two ridiculously spoiled cats. She occasionally pontificates on her blog.