Money and meals given to doctors by pharmaceutical companies increased inappropriate prescribing, leaving patients with drugs that were more expensive, had fewer benefits or were not clinically necessary, a major global review finds.
The first-of-its-kind Cochrane review – considered the gold standard in healthcare research – analysed millions of doctors’ prescribing practices across 93 studies to understand how visits from sales representatives, sponsored educational opportunities and covered travel influenced prescribing.
The review, published on Friday, found that pharmaceutical company gifts and payments to doctors increased inappropriate prescribing and the number of prescriptions they wrote, and likely affected how much patients spent on prescriptions.
“Doctors often think that … they can’t be bought for the price of a sandwich but the data shows this is an effective marketing strategy,” said the review’s lead author, University of Sydney professor in pharmacy Barbara Mintzes.
“The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs,” Mintzes said.
The studies compared doctors who received payments and gifts or met with sales representatives with other doctors who did not meet with representatives, or who had fewer of these interactions.
Most of the studies included in the review were US-based because of the availability of vast amounts of detailed data, with pharmaceutical companies publicly reporting all payments to prescribers that could be compared with individual doctors’ prescribing data.
While it also included European reports, no Australian studies were included in the review because this granular-level data isn’t available.
But co-author Associate Professor Geoff Spurling at the University of Queensland said these marketing tactics were “all around the world, in every country … including Australia”, despite its national medical code of conduct setting clear restrictions on gifts, inducements and hospitality that could influence prescribing.
Pharmaceutical lobbying was “totally commonplace” in Australia, said Spurling, also a GP.
“A lot of doctors will say, ‘Oh, a cheap meal’s not going to be an issue’, or, ‘a pen’s not going to be an issue’. But of course it is an issue, and the review found that even $13 meals influence prescribing,” Spurling said.
“The problem for doctors is that they think … they’re too smart to be influenced, and that may even make them more vulnerable.”
Measures of appropriate prescribing differed across papers. One study found clinicians prescribed more antibiotics for coughs and colds if they were more exposed to promotional interactions. Another measured how often doctors prescribed opioids at a dangerous dose level.
“[On] the flip side, the doctors who were having [fewer] interactions with pharmaceutical companies were prescribing more appropriately,” Mintzes said.
Environments with strong conflict-of-interest policies also had more appropriate prescribing, she said.
Dr Adrian Pokorny, a Sydney-based medical oncologist and co-author of a separate, Australian-based report published earlier this year, said the review’s findings were “completely unsurprising”.
His study found that more than 104,000 payments to attend educational meetings, worth $164.4 million, were made to about 23,500 Australian healthcare professionals between 2015 and 2024.
“There’s a really small percentage [1 per cent] of clinicians who receive the lion’s share of these payments from industry,” Pokorny said.
Almost 86 per cent of specialists in Pokorny’s specialty – haematology and oncology – received at least one payment from a pharmaceutical company between 2015 and 2024.
Pokorny said doctors’ involvement with the pharmaceutical industry was, in some ways, unavoidable, given their sponsorship of clinical trials and conferences.
“It’s a difficult one because … you can’t say that we should have absolutely no interaction with the pharmaceutical industry whatsoever,” he said. “It’s not like anybody else has put up their hand to do adequate education for clinicians.
“But the research is driven by profit and … when it becomes a financial relationship, it becomes very murky because, as the Cochrane review rightly shows, those financial relationships can affect prescribing.”
Royal Australian College of General Practitioners president Dr Michael Wright said the review raised legitimate concerns about the influence of commercial relationships on prescribing behaviour but said Australia has protections in place under the medical code of conduct.
A spokesperson for the Medical Board of Australia said it took regulatory action when practitioners failed to appropriately manage conflicts of interest, including by accepting gifts or inducements that could affect, or be seen to affect, their professional judgment.
Medicines Australia’s disclosure log provides the public with a searchable database of significant payments and transfers made to healthcare professionals by its pharmaceutical company members.
Australian Medical Association vice president Associate Professor Julian Rait said doctors must manage relationships with pharmaceutical companies appropriately.
“The overriding principle guiding doctors’ relationships with industry is the primacy of patient care,” Rait said in a statement.
“Patients and the wider community expect doctors to uphold this duty and put patients’ interests above their own personal interests or the interests of industry.”
Mintzes said implementing stronger conflict-of-interest policies across hospitals, government and medical schools would improve prescribing and protect patients.
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Disclaimer : This story is auto aggregated by a computer programme and has not been created or edited by DOWNTHENEWS. Publisher: www.smh.com.au
