Physicians who receive lots of pharma cash prescribe more brand-name drugs, study finds

An analysis from ProPublica has finally substantiated the long-disputed claims that the payment physicians receive from pharmaceutical companies and medical device makers influence how they prescribe medicine. Physicians who receive such payments do in fact tend to prescribe more brand-name medications on average.

Researchers matched records on payments from pharmaceutical and medical device makers in 2014 with corresponding data on physicians' medication choices under Medicare Part D. They evaluated physicians who wrote at least 1,000 prescriptions in five large medical specialties, including family medicine, internal medicine, cardiology, psychiatry and ophthalmology.  

Here are six findings from ProPublica's analysis.

1. Physicians who received payments from pharmaceutical companies and device makers — even in the form of a meal — prescribed a higher percentage of brand-name drugs than those that didn't receive payments. Physicians who received industry payments were two to three times more likely to prescribe brand-name drugs at high rates compared to their peers in their respective specialties.

2. Those who received more than $5,000 from drug or medial device makers usually prescribed the most brand-name medications. For example, internists who did not receive payments prescribed brand-name drugs at an average rate of 20 percent, compared to 30 percent for those who received more than $5,000.

3. The analysis doesn't show that payments influence physicians to prescribe certain drugs, or even a particular company's drugs. Instead, it reveals that industry payments are associated with prescribing practices that benefit pharmaceutical companies' bottom lines. 

4. Other studies have repeatedly shown that generic drugs are equally effective as brand names for most patients and cost substantially less money. Additionally, patients report relatively the same level of satisfaction with generic and brand name drugs, according to the report.

5. Richard Baron, MD, president and CEO of the American Board of Internal Medicine, said the findings of ProPublica's analysis make sense, and that physicians today often have to put more effort into avoiding industry payments than receiving them. "You have the people who are going out of their way to avoid this and you've got people who are, I'll say, pretty committed and engaged to creating relationships with pharma," Dr. Baron said, according to the report. "If you are out there advocating for something, you are more likely to believe in it yourself and not to disbelieve it."

6. Of the specialties analyzed by ProPublica, ophthalmologists who received payments of more than $5,000 in 2014 had the highest brand name prescribing rate (64.6 percent), followed by internal medicine physicians (30.1 percent), family medicine physicians (25.8 percent), cardiologists (24.1 percent) and psychiatrists (18.9 percent). However, various other factors contribute to physicians' choices for which medicines to prescribe. For instance, some specialists treat patients for conditions for which few generic options are available. Several physicians who received large industry payments and who had higher than average brand name prescribing rates said their prescribing practices intend to serve their patients' best interests.

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