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A study in the journal JAMA Internal Medicine finds that doctors are more likely to prescribe brand-name medications when the drug company offers them a free lunch.

Your fate may depend on how well your doctor likes a free ham sandwich.

In the United States, the Open Payments program has tracked payments to physicians from drug companies. To no one's surprise, studies have found that doctors who receive consulting payments of US $2000 or more per year from drug companies tend to prescribe brand-name medications made by those companies. However, it doesn't take $2000 to change a doctor's opinion. A team of researchers from the University of California at San Francisco and the University of Hawaii have found that as little as a free lunch seems to encourage doctors to prescribe drugs made by the company that pays for the lunch.

267,669 Doctors Can Be Wrong

The research team analyzed industry data from the Open Payments program for 267,669 doctors in the United States. This data base identifies American doctors who receive payments from pharmaceutical companies, and how much they receive. The researchers compared payment data against prescriptions for patients receiving Medicare Part D, a prescription insurance option that can be purchased by Americans who are on Medicare.

Data analysis revealed that the 267,669 doctors in the program received 65,234 payments from drug companies, but 95 percent of those payments were for $20 or less, typically in the form of a free meal served at a seminar about a new medication. The researchers only studied doctors who wrote more than 20 prescriptions a year for a given brand-name drug, and only brand-name drugs that have been on the market for 5 years or more for which less expensive generic drugs are available. Then the researchers calculated how many lunches were necessary to persuade doctors to prescribe the more expensive but functionally equivalent medications.

The Relationship of Small Incentives to Prescriptions of Four Common Medications

One of the medications studied was Crestor, the cholesterol-lowering medication that is now available as generic rosuvastatin. When doctors didn't attend any luncheon seminars at all, Crestor accounted for on average 8 percent of all their prescriptions for statin drugs. When doctors attended at least one luncheon sponsored by the makers of Crestor, that figure jumped to 12 percent. When doctors were able to grab lunch and listen to a spiel about Crestor three times, the prescription rate increased to 14 percent, and for four lunches, the rate was 16 percent.

Another of the medications studied was Bystolic, which is available as a generic called nebivolol. This drug is a cardioselective beta-blocker. It lowers blood pressure by reducing nerve activity in the heart without as affecting nerve activity in other parts of the body. When doctors had not attended any lunch seminars sponsored by the maker of the drug, they prescribed it just 3 percent of the time when they prescribed any beta-blocker drug. If they had attended one lunch seminar, they prescribed it 8 percent of the time. If they had attended four lunch seminars, they prescribed it 16 percent of the time. That's a five-fold increase in prescriptions for the price of four sandwiches.

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  • DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. 2016 Jun 20. doi: 10.1001/jamainternmed.2016.2765. [Epub ahead of print] PMID: 27322350.
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