It may seem obvious that doctors who receive payments from medical drug and device makers tend to prescribe more brand-name drugs than colleagues who don’t. But now there’s research to back it up.
ProPublica, the Pulitzer Prize-winning independent newsroom, produced the report titled “Dollars for Docs” after analyzing the prescribing patterns of physicians who wrote at least 1,000 prescriptions in Medicare Part D—the federal government’s prescription drug program that covers more than 39 million Americans, paying for at least one in four prescriptions in the U.S.
The report looked at data on payments from pharmaceutical and medical device companies in 2014, with data on medications prescribed by physicians in Medicare Part D. It observed the prescribing patterns of doctors across five common specialties: psychiatry, cardiovascular disease, family medicine, internal medicine and ophthalmology.
“Payments” included meals, royalties, promotional speaking, consulting, business travel and gifts. And sure enough, their analysis found that overall, the more money doctors receive from the medical industry, the more they prescribe a higher percentage of brand-name medications.
Though at first glance, this report may incite general disdain for the medical industry and greedy doctors, Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who provided guidance in the analysis, clarifies that this report is less about proving that industry payments sway doctors to prescribe certain drugs, but that it “again confirms the prevailing wisdom … that there is a relationship between payments and brand-name prescribing.”
ProPublica goes on to note that there’s no real difference between brand-name and generic drugs. Generics go through the same FDA standards and often work just as well as name brands for a cheaper price—they’re just not as heavily advertised.
However, Dr. David W. Parke II, chief executive of the American Academy of Ophthalmology, pointed out that some doctors have little choice but to prescribe name brands—for example, if they are treating patients with HIV/AIDS or other complicated conditions that have few or not as effective generics available. “In some cases, there are very appropriate and clinically valid reasons” for doctors who are outliers in their prescribing, he said.
The results show that as payments increased, brand-name prescribing rates increased as well, at a rather steady rate. For example, the brand-name prescribing rate of internal medicine doctors who received no payments was 19.8%—compared to the 30.1% prescribing rate of internal medicine doctors who received over $5,000 from medical drug or device makers.
This pattern is higher in some states—in Nevada, over 90% of doctors received at least one payment from a company in 2014—and lower in others—less than 20% in Vermont. But regardless, it’s seen widely across the U.S. “You can debate if these payments are good or bad, or neither, but what isn’t debatable is that they permeate the profession,” said Dr. Walid Gellad, associate professor of medicine at the University of Pittsburgh and co-director for its Center for Pharmaceutical Policy and Prescribing.
ProPublica has listed the top 50 companies that dispense payments and the highest-earning doctors as part of its report. It has also created a search engine where you can search whether your doctor has received drug company payments.