The international analysis, published in the Cochrane Database of Systematic Reviews, compared prescribers who had contact with drug firms against those who had less or none. It looked at prescribing volumes, costs and how well treatment matched patients’ needs.
Most of the studies, 62, examined payments and gifts. Doctors who received them prescribed more, particularly products promoted by the paying company, and were more likely to choose treatment later judged inappropriate. Costs rose for health systems and patients alike.
“In the United States, where companies must report payments to doctors in a public database, just over half of all licensed doctors accepted a payment, including free meals, from a pharmaceutical company”, said co-author Professor Quinn Grundy of the University of Toronto. “That’s important because it shows companies focus their marketing resources on doctors who will deliver the highest return on investment by prescribing more promoted drugs”.
Grundy said the practice is widespread, though many doctors decline such offers and remain independent of industry influence.
Another 16 studies looked at marketing aimed at doctors, mainly visits by company representatives. These were also tied to heavier prescribing, poorer treatment choices and higher costs, although the researchers were less certain of those findings. Evidence on free drug samples was inconclusive.
Eight further studies examined hospital and clinic rules restricting sales visits, gifts and samples. Such policies were associated with more appropriate prescribing and may have reduced the number of drugs prescribed.
Grundy said this shows workplaces can be designed to protect doctors’ independence, but the responsibility should lie with medical institutions and health systems rather than individual physicians.
The authors called on medical organisations, professional associations and universities to better recognise the influence of drug marketing on clinical decisions and to introduce rules limiting it. Prescribers, they said, also need independent, evidence-based information.
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Source: PAP