WASHINGTON -- Physicians and other health care providers who received "gifts" from pharmaceutical companies were much more likely to prescribe a higher number of drugs per patient, including more costly prescriptions for branded medicines, compared to prescriptions written by medical providers who did not accept gifts, according to research published in PLOS ONE.
Gifts of any size had an effect on prescribing, and larger gifts elicited a larger impact, according to study findings. These gifts varied in value from as little as $7 a year (i.e. a dozen doughnuts), to as much as $200,000 in cash, say researchers from Georgetown University Medical Center (GUMC) and George Washington University Milken Institute School of Public Health. Their study was funded by the District of Columbia Department of Health.
The deep dive into pharmaceutical gift spending and Medicare Part D prescriber reports filed for 2013 for the Washington D.C. area found that almost 40 percent of these providers accepted $3.9 million worth of money, meals, trips, and other gifts. (Medicare Part D is a federal prescription drug program that covers patients over age 65 or who are disabled.)
There are no national laws that prohibit the acceptance of gifts or payments from industry by healthcare providers, but that should be changed in order to protect patient health, says study investigator Adriane Fugh-Berman MD, professor in the department of pharmacology and physiology at GUMC.
"Every slice of pizza given to a physician compromises patient health," adds Fugh-Berman, director of PharmedOut, a research and education project that examines pharmaceutical industry marketing and supports evidence-based, cost-effective prescribing.
"Industry gifts influence prescribing behavior, cost taxpayers money and should be banned," she says. "Our finding that gifts from pharmaceutical companies result in more prescriptions per patient is particularly concerning, because the more medications a patient takes, the higher the risk of adverse effects," says Susan F. Wood, PhD, professor in the department of health policy and management and director of the Jacobs Institute of Women's Health at George Washington University's Milken Institute School of Public Health. Fugh-Berman and Wood are the study's co-senior authors.
While previous research has raised the issue of influence of pharmaceutical gifts on physician care, this study is unique in that it looks not only at doctors, but at other providers of medical care including nurse practitioners, physician assistants, podiatrists and others who reported prescribing medicine using Medicare Part D.
A further strength of the study is the inclusion of data from a Washington D.C. Department of Health program (DC AccessRx) that requires pharmaceutical companies to report gifts to D.C. providers. The federal Center for Medicare and Medicaid Services (CMS) Open Payments (OP) program also lists gift payments, but only to physicians and teaching hospitals.
Using these two databases, the researchers matched gifts with provider information using the CMS 2013 Medicare Provider Utilization and Payment Data. In this way, they uncovered links between prescribing history and gift taking in 2,873 providers in D.C. during 2013.
Among the findings are:
- Gift recipients prescribed an average of 892 claims each, more than twice as many as the 389 claims per prescriber for non-gift recipients;
- Compared to non-gift recipients, gift recipients prescribed 7.8 percent more branded drugs;
- Physicians who received small gifts (less than $500 annually) had more expensive claims ($114 vs. $85) and more branded claims (30.3 percent vs. 25.7 percent) than physicians who received no gifts; and
- Physicians receiving large gifts (greater than $500 annually) had the highest average costs per claim ($189) and branded claims (39.9 percent) than other groups.
"This study clearly shows that even small gifts change the practice of medicine," says Fugh-Berman. "Gifts, no matter their size, have a powerful effect on human relationships, and pharmaceutical companies are well aware of that."
Study co-authors include Alycia Hogenmiller from GUMC; Joanna Podrasky, MPH, from JPS Health Network in Fort Worth, Texas; Meghan McMonagle, MPH, from MedStar Health in Columbia, Maryland; Janani Raveendran from George Washington University School of Medicine; and Tyler Bysshe, MPH, from the National Opinion Research Center at the University of Chicago.
The authors report the following disclosures: Hogenmiller is the paid project manager of PharmedOut. PharmedOut has a contract with the George Washington Milken Institute School of Public Health to create content for the DC Center for Rational Prescribing (DCRx), which creates industry-free continuing medical education modules and resources for the Washington DC Department of Health. Fugh-Berman directs PharmedOut and also has a contract with the George Washington Milken Institute School of Public Health to analyze pharmaceutical marketing data from Washington DC. Fugh-Berman is a paid expert witness at the request of plaintiffs in litigation regarding pharmaceutical marketing practices. Wood is the PI for the DC Center for Rational Prescribing, a contract with the Washington DC Department of Health to create industry-free continuing medical education modules and resources for the Washington DC Department of Health. McMonagle and Podrasky were former employees of the DC Center for Rational Prescribing; Raveendran is a former intern for DCRx.
About Georgetown University Medical Center
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook, Twitter @gumedcenter and Instagram (@gumedcenter).