Docs Who Accept Drug Companies' Money More Likely to Prescribe Their Drugs

Compared to physicians who receive no money, those who were paid for meals and lodging from drug makers had higher odds of prescribing that company's cancer drugs.

Physicians who accepted money from drug companies for meals, talks, and travel were more likely to prescribe those companies’ drugs for two cancer types, a new study in JAMA Internal Medicine shows.

"The main takeaway is that oncologists who received money from a pharmaceutical company were more likely to choose that company's drug the following year," said study lead author Aaron Mitchell, MD, a fellow in the UNC School of Medicine Division of Hematology & Oncology.

Researchers analyzed prescriptions for Medicare patients with two cancers where there are multiple treatment options: metastatic renal cell cancer, and chronic myeloid leukemia.

"We wanted to look at cancer types for which there were several similar medications to choose from," Mitchell said. "Further, we wanted to look at cancer types where the different treatments would all be considered as 'standard of care' based on FDA approval and NCCN recommendation. RCC and CML and the associated drug sets best met these criteria.

They used publicly available data from 2013 to 2014 that was reported through Open Payments, a provision of the federal Patient Protection and Affordable Care Act that required drug makers to disclose gifts or transfers in value greater than $10 to physicians and teaching hospitals.

Compared to physicians who received no money, those who were paid for meals and lodging from a drug maker had higher odds of prescribing that company's drug for metastatic renal cell carcinoma and for chronic myeloid leukemia.

For metastatic renal cell cancer, physicians who received any payment in 2013 had twice the odds of prescribing that company's drug, and for chronic myeloid leukemia physicians who received any general payment had 29% higher odds of prescribing that company's drug.

A review of specific drugs found a significant decrease in the use of the leukemia treatment imatinib when physicians received payments. Novartis makes both imatinib and another treatment, nilotinib.

Since imatinib was about to lose its patent protection, the authors said the finding suggests that payments were done in the hope of "switching" physicians from the older drug imatinib to the newer drug nilotinib.

Mitchell said the "proof-of-principle" study was designed to see if there was a link between industry payments and the cancer drug prescriptions, but he cautioned that it does not show a cause-and-effect relationship, and that the payments are not improper.

"Industry payments to physicians are entirely above-board and legal," he said. "Whether they are unethical is an area of ongoing debate in the medical community, which different physicians would disagree about."

"None of these drugs would be considered more effective than the other as based on FDA approval and recommendation by the NCCN," he said. "Furthermore, if a medication's use were due to it being more effective, then we would expect to see higher use of that drug among all physicians, with no difference between those who did and did not receive money from the drug's manufacturer."

Mitchell said he can't say if the influence of the drug industry affects a broad array of drugs beyond the ones examined in the study, but "we think this is a worthwhile question."

"In terms of other areas of medical practice besides oncology, other researchers have suggested that this may be quite ubiquitous," he said. "Similar associations have been found for blood pressure drugs, cholesterol drugs, anti-depressants, and others."

Mitchell said it is the responsibility of each physician to decide whether they want to enter a financial relationship with the drug industry, and that of the patient to decide whether this information will influence their choice of physician.

"As this potential problem gets increasingly recognized, I would look toward physician professional societies and patient advocacy groups to raise awareness and call for more transparent and restrained behavior on the part of physicians," Mitchell said. 

"Many academic institutions and medical centers have instituted conflict-of-interest policies in order to manage any real or perceived bias from physician-industry relationships, though this is by no means universal."