New Study Finds Doctors Prescribe More Generics When Drug Reps Curtailed

We’ve raised questions before about the influence of Big Pharma on doctors and patients and the ethics of the way drugs are sold in this country. For starters, we’re one of only two countries in the world that allow direct-to-consumer advertising about drugs. Even the free meals given to doctors at hospitals have an impact on the way they practice medicine.

But now there is conclusive evidence that drug representatives have an effect on how doctors prescribe drugs, according to a study published in the journal of the American Medical Association on May 2. The study found that doctors prescribe more generics when greater restrictions are placed on pharmaceutical sales reps at teaching hospitals.

According to JAMA’s editor in chief, Dr. Howard Bauchner, the study makes clear the need to limit pharmaceutical company marketing in teaching hospitals “as a way of ensuring that there’s no influence, no inappropriate influence over prescribing.”

The Skinny on the Study

Led by Ian Larkin, an assistant professor of strategy at the University of California Los Angeles Anderson School of Management, the study focused on 19 teaching hospitals in five states.

These 19 teaching hospitals restricted visits by drug representatives in one or more ways: by limiting their access, limiting gifts, or by punishing rule-breakers. Larkin’s team compared prescriptions by 2,126 doctors at those hospitals with 24,593 peers with similar characteristics who were not subject to the restrictions. In total, the team examined more than 16 million prescriptions, using data from the pharmacy benefit manager CVS Caremark.

The researchers found statistically significant changes in six out of eight drug classes and at nine of the 19 hospitals.

The average promoted drug had a market share of 19.3 percent before the policies. Hospital policies that govern pharmaceutical marketing, or “detailing” as it’s called, were associated with a 1.67 percentage point decrease in market share for the average promoted drug. The teaching hospitals with tougher policies, that is, those that enforced the policies with disciplinary actions, appeared to have more significant results

However, there are some limitations to the study and its findings. First, the study showed correlation but not causation; in other words, it did not prove that the policies caused the change in prescribing. Additionally, the study was observational, which means doctors were not randomly assigned to hospitals and the researchers took the hospitals’ policies at face value, without following up on implementation.

Still, the results of the study are strong and indicative. Logic would follow that doctors who are exposed to free food, gear, and other perks from brand name drug companies would be affected, if for no other reason than the brand name drug being top of mind.

“These weren’t terribly onerous restrictions, yet at the same time, they changed prescribing in a way that has really significant cost implications,” Larkin said.

The JAMA issue in which this study was published was devoted entirely to conflicts of interest in medicine. Conflicts of interest in the healthcare industry have become more visible thanks to recent whistleblowers and lawsuits.

History of the Pharma Problem

Healthcare fraud costs the United States about $272 billion a year. It robs Americans of their hard-earned savings, and potentially even their health.

Whistleblower lawsuits not only get justice for the people hurt by fraud, but they also help and regulate the healthcare industry. At least eleven pharmaceutical companies settled whistleblower lawsuits for illegal marketing and kickbacks between 2009 and 2014, largely contributing to shedding light on the impact Big Pharma has on the industry.

As part of settlements, some companies were required to disclose payments to physicians for promotional speaking, consulting, and other services. Yet, some pharmaceutical companies tried to skirt the terms of the settlements, posting the information on their websites where it was difficult to find, search, and analyze.

The Open Payments program and ProPublica’s Dollars for Docs remedied that problem, bringing more transparency to the industry.

The Open Payments program, or the Physician Payments Sunshine Act of 2010, was established as part of the Affordable Care Act to collect and track all financial relationships between drug and medical device manufacturers and physicians and teaching hospitals.

ProPublica, a nonprofit investigative news organization, built a tool in 2014 with that data that lets users look up their physicians’ payments from drug and medical device companies, for the first time facilitating public disclosure of relationships between doctors and Big Pharma.

The results from the JAMA study are in line with ProPublica’s findings and analysis. In their analysis of the data from their Dollars for Docs, finding that the more money doctors receive from drug and medical device companies, the more brand-name drugs they tend to prescribe.

Big Pharma’s Influence in Action

Doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at “exceptionally high rates” as others in their speciality, according to ProPublica.

Data from 2014 showed that those who received more than $5,000 from companies that year had the highest brand-name prescribing percentages. For example, internists who received no payments prescribed brand-name drugs at an average rate of 20 percent, while those who received more than $5,000 prescribed brand-name drugs at a rate of 30 percent.

ProPublica’s analysis did not prove that industry payments impacted doctors to prescribe particular drugs, or even a specific company’s drugs. But it suggested that drug company payments were linked to an approach to prescribing drugs that ultimately drives up profit for drug companies.

These findings become more problematic once we consider that generics work as well as name brands for most patients. Generics are typically cheaper than brand name drugs, are not as heavily advertised, and must meet strict FDA standards. According to Iodine, a website that is building a repository of user reviews on drugs, patients do not report a significant difference in satisfaction between brands and generics.

How Can I Make Sure My Doctor is Fairly Prescribing Medicine?

The editorial that accompanies the JAMA study, written by Colette DeJong and Dr. R. Adams Dudley of the University of California, concludes that the healthcare industry should be concentrating on providing and considering alternatives for the dissemination of information about drugs. Instead of relying on companies to promote their own medicines, which creates a conflict of interest, they say we need to investigate the effectiveness of drugs independently and work to lower costs for patients.

Until hospitals across the country limit drug reps’ access, the onus lies on you to either come forward as a whistleblower or be an informed patient. If your doctor is in the Dollars for Docs database, you simply type in their name, and you can see who paid them, in what amounts, and for what purpose. This can come in handy, for example, if your doctor prescribes you a drug that has mixed reviews.

Time to Stop Pharmaceutical Misconduct

Research such as this JAMA study has shown that aggressive pharmaceutical marketing may be a driving force in systemic overprescribing across the nation. Tragically, over 200,000 Americans die from prescription drug use each year – over 50,000 died last year from the opioid crisis alone.

And, because of Big Pharma’s lack of transparency, there could be other potentially harmful drugs that are being overprescribed that we may not even be aware yet.

In order to end Big Pharma’s influence over the drug industry, healthcare workers and patients need to work together. If you’ve witnessed fraud in the medical industry, do not hesitate to speak up. Find out how a whistleblower attorney can help.