Pharmaceutical company marketing negatively influences prescribing
Doctors' prescribing habits are heavily influenced by payments, gifts and free meals from pharmaceutical companies, leading to more prescriptions for more expensive, less appropriate drugs, a new Cochrane review finds. This can seriously harm both individual patients and health systems.
This review explores how pharmaceutical marketing impacts doctors' prescribing habits, leading to increased use of more expensive and less suitable medications. Pharmaceutical companies employ various strategies to promote their drugs, including sales reps, gifts, meals, travel expenses, and advertising. The review, published in the Cochrane Database of Systematic Reviews, analyzed 93 studies, with most focusing on real-world prescribing patterns in the United States due to the Sunshine Act.
The review categorized pharmaceutical interactions into advertising and education, gifts and payments, and free samples. Advertising and education were associated with less clinically suitable and more costly prescriptions, with strong evidence that they also led to higher prescription volumes. Gifts and payments consistently showed a link to less appropriate prescribing, more prescriptions, and probable cost increases, though evidence on free drug samples and their impact on hospitals' formularies was sparse or weak.
The study author, Dr. Lisa Bero, emphasized that more contact with drug company promotion results in less appropriate, frequent, and expensive prescriptions, affecting patient care negatively. Dr. Bero highlighted that even inexpensive meals increased opioid prescriptions, and the more payments a doctor received from opioid manufacturers, the more likely they were to prescribe dangerously high opioid doses.
The opioid crisis in North America exemplified inappropriate overprescribing, but the authors noted that this was not an isolated incident, as similar issues are common within the industry.
The review found a clear dose-response relationship between free meals and inappropriate prescriptions, with more meals received leading to prescriptions of the company's drug. While some hospitals and medical centers have conflict-of-interest policies to limit industry interactions, these policies effectively mitigate the negative impact on doctors' prescribing habits.
The authors stressed that the issue is not about a few bad apples but about improving the system, with strict conflict-of-interest policies being a promising solution.
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