Pharma payments associated with increased prescribing, systematic review finds

The review of 36 published studies found a consistent association between physicians' payments from pharmaceutical companies and prescribing of those companies' drugs as well as temporal and dose-response relationships, suggesting the association was causal.


U.S. physicians who took financial payments from the drug industry increased their prescribing of the paying companies' drugs, a systematic review found.

Researchers reviewed 36 published studies including 101 analyses to evaluate whether physician payments from the drug industry were associated with prescribing practices. Payments included both cash (typically for consulting services or invited lectures) and in-kind gifts, such as meals. The study results were published Nov. 24 by Annals of Internal Medicine.

From 2015 to 2017, 67% of all U.S. physicians received payments. This proportion exceeded 80% in some specialties (medical oncology, orthopedic surgery, urology, and others), and in many specialties the dollar value of personal payments increased in recent years. An association between gifts and prescribing was found in every study and among all specialties and drug types, including cancer drugs and opioids. Thirty studies identified a positive association between payments and prescribing in all analyses, while six had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association.

Payments were associated with increased prescribing of the paying company's drug, higher prescribing costs, and more prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association, and 25 assessed and found evidence of a dose-response relationship. The authors noted that the studies were observational, that 21 of 36 studies had serious risk of bias, and that publication bias was possible.

“Taken together, our results support the conclusion that personal payments from industry reduce physicians' ability to make independent therapeutic decisions and that they may be harmful to patients,” the researchers wrote. “The medical community must change its historical opposition to reform and call for an end to such payments.”