The Cost of a Free Meal: Why Big Pharma's Gifts to Doctors May Not Be So Harmless

Posted on February 11, 2021

It’s no secret that Big Pharma has found itself in some morally and legally questionable spots. Because the industry’s role in medical innovation is essential to our healthcare system, patients and many healthcare providers tend to overlook the more unsavory aspects of the business.

It’s time to stop overlooking pharmaceutical industry misconduct. Over 200,000 Americans die from prescription drug use each year, and research has shown that aggressive pharmaceutical marketing may be a driving force in systemic overprescribing across the nation.

Even the World Health Organization has expressed concern about financial motives potentially compromising Big Pharma’s core healthcare role, highlighting ‘“an inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers and the public to select and use drugs in the most rational way.”’

Legislative reform can help resolve this crisis, but we as a society first need to start using the tools we already have. Without the public putting considerable pressure on the pharmaceutical industry, meaningful reform is unlikely to happen.

The Open Payments Database

The Open Payments database is a federally provided tool. It gives the public access to information about payments that pharmaceutical companies have made to doctors contracted with federal healthcare programs.

If your doctor is in the database, you simply type in their name, and you can see who paid them, in what amounts, and for what purpose.

Many still claim that these “gifts” have absolutely no effect on the prescribing behaviors of doctors, and that all pharmaceutical reps are simply educating doctors on their drugs.

When someone gives you gifts over and over, however, you may have to actively resist being biased towards that person or their company. At the very least, if one product is top-of-mind because the company selling it is regularly in contact with you, you may inadvertently consider it before other products.

That’s why the Propublica and Harvard study released in March 2016 showing the patterns between Pharma payments and prescription behaviors is such an imporant milestone.

Propublica investigates Big Pharma’s impact

The study examined the prescribing patterns of Massachusetts’s doctors in the Medicare database.

It showed that doctors who received over $2,000 in Big Pharma payments in 2011 tended to increase their brand name prescriptions at a rate of 0.1 percent for every additional $1,000 they received.

That may seem a low rate, but consider that the top five earners of Big Pharma payments in 2014 received over $20 million throughout the year. The cost of brand-name drugs can be high for patients, so it’s important to understand what motivates the choice of brand-name prescriptions over more affordable generics.


There are many reasons that doctors may prescribe certain drugs over others, but it’s important for the public and policy makers to have access to as much research as possible on Pharma’s possible influence over those prescribing patterns.

This information can help ensure that doctors and pharmaceutical companies consider patients’ best interests first and foremost.

Why transparency matters

Reforming healthcare demands considerable effort on many different levels. Getting there will take the concerted efforts of pharmaceutical companies, the government, healthcare workers, and patients.

America’s opioid epidemic has continued to concern and baffle the public. Though many people’s instinct is to blame addicts for abusing these drugs, we need to be a lot more demanding of answers from the pharmaceutical industry and the healthcare sector. Prescription drugs can eventually get into the wrong hands, but they do not originally come from thin air.

Investigations have shown that OxyContin manufacturer Purdue was fully aware of its products’ potential to cause addictive behaviors, and continued to sell it for decades. The company’s internal documents and marketing memos have suggested a specific intent to mislead consumers and doctors in order to generate higher revenue.

Oxycontin’s primary selling point is that it allegedly lasts for 12 hours, when this has been proven to be untrue.

And that matters, because Purdue spent hundreds of millions of dollars marketing Oxycontin to doctors as a supposedly better alternative to generics. So, having full transparency around those “gifts”—whether they are meals, speaking fees or otherwise—absolutely matters.

What you can do

There are two realities about Big Pharma that our nation has yet to reconcile:

  • Big Pharma is a business, and its primary objective is to make money.
  • Big Pharma is in the healthcare business, and it has a moral responsibility to protect and preserve the best interest of patients.

In our current healthcare system, these objectives have to coexist. Unfortunately, the moral responsibility to protect patients is consistently underrepresented in the actions of pharmaceutical companies.

What else can be done, then?

The kind of legislation Big Pharma should be subject to (such as not being allowed to market drugs directly to consumers, or having limits on the amounts they can gift to doctors) is unlikely to happen until the industry’s unethical behavior significantly hurts their bottom line.

The top pharmaceutical companies have all paid fines and settlements, many in the billions. The reality is: in comparison to their overall revenue, those fines are a drop in the bucket for Big Pharma.

This is just one of many reasons that it’s important for more doctors, nurses, and pharmaceutical employees to report fraud. Fraud and misconduct are rampant in the healthcare sector, and particularly in the pharmaceutical industry. If everyone who witnessed fraud reported it, there could be far greater pressure on the industry to develop more ethical practices.

Big Pharma has a lot of money and a great deal of power, but it could not prosper without considerable cooperation from doctors and patients. When we notice something wrong and fail to speak up about it, we are complicit.

As a patient, using tools like Open Payments is a critical step in taking control of your own healthcare. The point of that tool, as well as Propublica’s correlated Dollars for Docs database, is not to shame or blame doctors.

The point is to create a more transparent and trustworthy system, where healthcare providers and patients are both fully informed and fully empowered.