A Free Meal From a Drug Company Can Determine What a Doctor Prescribes You

They say there's no such thing as a free lunch… but what if what you're offering in return for a sandwich or plate of pasta is the fate of a medical patient?

A meal may be all it takes to alter what medications doctors prescribe for Medicare patients, according to a recent study in the Journal Of The American Medical Association-Internal Medicine.

The new study, led by Dr. Adams Dudley of the University of California San Francisco, examines how even small gifts and payments from pharmaceutical companies can influence doctors' prescription patterns and incline them to dispense name-brands rather than generics or other therapeutic alternatives.

The study utilized the recently disclosed prescribing information of 280,000 doctors in Medicare's prescription drug program from 2014 and 2015, as well as data from nearly 64,000 drug company payments to physicians.

At the very center of the study are meal payments—most of which cost less than $20.

Providing meals for doctors is a widespread practice by drug companies, ostensibly for educational purposes in order to inform physicians about their products. These meetings could take place briefly over lunchtime, or during a longer seminar during which a doctor may also be comped for his travel and lodging expenses.

However, these payments are just small potatoes compared to the tens of thousands of dollars that some doctors receive from drug companies in honorariums in order to give lectures or conduct research on behalf of the corporations.

But that's exactly the point, says Collette DeJong, one of the co-authors on the paper:

"You might ask, 'When some doctors are getting $50,000, why are you looking at the $10 bagel sandwiches?' The majority of doctors are not getting a $10,000 speaking fee, they are just getting the lunches and the dinners, so 80 percent of payments [to doctors] were just food and beverages. We wanted to look at the payments that reflected by far the most common interaction between drug companies and doctors."

Dr. Dudley continues: "Even though there are bigger payments out there, they just affect [a] much smaller number of doctors. The main way that the pharma industry interacts with doctors is to sponsor meals where 30 doctors come at a time."

Indeed, there seems to be something dubious in the banality of these cheap, food-court interactions between drug companies and doctors. Although there are both medical and pharmaceutical ethical practices, they apparently aren't enough to keep doctors from being influenced when dispensing prescriptions.

There's a "really tight association between the tiniest payment and the physician prescribing," says DeJong.

The American Medical Association ethical guidelines state that physicians should, "Decline any gifts for which reciprocity is expected or implied."

Meanwhile, the Pharmaceutical Research and Manufacturers of America, an industry group, states that they will not provide "educational" items in excess of $100. Their guidelines also state that "modest" meals are appropriate "to be offered as a business courtesy to the healthcare professionals as well as members of their staff attending presentations, so long as the presentations provide scientific or educational value."

What this study suggests is that the amount of money spent to influence a physician is actually a considerably less dollar value than in existing ethical protocols.

Getting doctors to prescribe name-brands by picking up the check at meal time has proved to be a reliable strategy for drug companies. Dudley and his team estimate that patients could save around $75 billion a year by using suitable generics.

And that's incredibly important because every single drug examined in their study has a generic that is acknowledged to be just as effective and significantly cheaper than the name-brand equivalent. It's not just Dudley's team that recognizes this either, it's also established medical bodies like the US Department of Veterans Affairs and the British National Health Organization.

A doctor attending a meal to discuss these drugs "would be less, not more likely to prescribe [them]" says Dudley, "because they would get the message that this costs more and has no benefit."

However, the research demonstrates the complete opposite: invariably, doctors are more inclined to prescribe name brands that have no additional benefit and can cost up to 80 times more, when courted with free meals.

DeJong stresses that this is particularly important for elderly people who are juggling ten or 20 monthly medications. The price between just a single generic and a name brand can be humongous—with multiple drugs, it can be enough to make someone living on a fixed insolvent.

Fortunately this new study does shed some much needed light on the interactions between drug companies and physicians—and the very real effects this can have on the pockets of people on Medicaid. Just as importantly, it clearly (in this writer's mind, anyway), suggests the need for the medical and pharmaceutical establishments to scrutinize their own ethical policies, particularly in relation to food.

As MUNCHIES has pointed out before, eating is rarely as simple an emotional and social undertaking as it seems. The conclusion here reinforces the notion that there is something fundamental in the sociality of the meal itself, rather than the payment to the doctor.

DeJong says, "If it's a five-dollar sandwich, it's clearly not about the money—it's about the time that's being spent between the doctor and the drug rep."