• Do gifts influence physicians?

    Massachusetts is considering repealing the gift ban law.  Since we are a research-based blog, here’s some of the best work on the effect of drug company gifts on physician behavior (h/t to Aaron S. Kesselheim):

    Manchanda P, Honka E.  Effects and Role of Direct-to-Physician Marketing in the Pharmaceutical Industry: An Integrative Review.  5 Yale J.Health Pol’y L. & Ethics 785 (2005). (ungated)  A thorough review of the literature.  On gift giving, it finds that the most common response to gift giving from drug reps is “reciprocation” and that physicians were less troubled by gifts under $100 (in 1990 dollars).

    A more disturbing finding is that these gifts induce reciprocal feelings among physicians. (at 809)

    Dana J, Loewenstein G.  A Social Science Perspective on Gifts to Physicians from Industry. JAMA, 2003 290: 252-5. (ungated)

    A recent study of medical residents found that 61% reported that “promotions don’t influence my practice,” while only 16% believed the same about other physician’s practices.  Clearly, it cannot both be true that most physicians are unbiased and that most other physicians are biased…bias is recognizable, but only in others…

    A research-informed understanding of conflict of interest has important implications for policy.  Specifically, the interventions mentioned earlier – limiting gift size, educational initiatives, and mandatory disclosure—are unlikely to eliminate bias because they rest on a faulty model of human behavior…

    Pharmaceutical companies know that gifts influence physicians, which is why many restrict their own employees from accepting even small gifts.

    Wazana A. Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift? JAMA, 2000 283: 373-80. (ungated) A review of 29 studies on physician – pharmaceutical company relationships.

    Gifts

    Receiving a gift and the number of gifts received correlated with the belief that pharmaceutical representatives have no impact on prescribing behavior; receiving gifts of high relevance to practice was also associated with a positive attitude…

    Samples

    Accepting samples was associated with awareness, preference and rapid prescription of a new drug, and a positive attitude toward the pharmaceutical representative.

    Industry-Paid Meals

    There was an independent association between benefiting from sponsored meals and formulary addition requests for any drug that was clearly dose-related.

    Funding for Travel or Lodging to Attend Educational Symposia

    Accepting funding to attend a symposium was independently associated with increased formulary addition requests for the sponsor’s drug…

    Pharmaceutical Representative Speakers

    Resident exposure to pharmaceutical representative speakers at lunch rounds was associated with dissemination and learning of inaccurate information about the sponsor’s and competitor’s drug…

    CME Sponsorship

    Drug company CME, sponsorship affected presentation content in that the sponsor’s drug was always preferentially highlighted, although the same drugs were discussed in each event.  Changes in prescribing practice (self-reported) in favor of the sponsor’s drug were also found…

    Honoraria, Research Funding, Employment

    Accepting a drug company honorarium to present data on a new therapy and receiving research support were independently associated with a formulary addition request for the sponsor’s drug as well as any drug.  One study examined the impact of employment but did not find it significant.

     

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    • 1. Everyone is subject to bias no mater what we do. BTW let us not forget that it is possible that for people to be biased against drugs, or newer drugs or for example against pain killers resulting in too little use.

      2. The research seems to yields an argument that requiring prescriptions is a bad idea because requiring prescriptions increases the chance that patients will delegate more drug discretion to doctors and do what ever their doctors recommend, which may not be best. It is also an argument for more out of pocket spending on drugs. BTW when we have told Doctors about our high deductible insurance they have changed prescriptions to generics.

      3. Doctors are not the people Paul Krugman hopes the are.