In news that really isn’t at all surprising — despite repeated denials from medical professionals — a new report found that doctors’ prescription habits are often influenced by the payments they receive from pharmaceutical and device makers.

An analysis from ProPublica found an apparent correlation between the payments they receive from pharmaceutical and medical device makers and the types of drugs they prescribe to patients.

The analysis matched records on payments from the industry in 2014 with data on family medicine, internal medicine, cardiology, psychiatry, and ophthalmology doctors who wrote more than 1,000 prescriptions for Medicare’s prescription part D patients.

While ProPublica points out that the new analysis doesn’t prove that payments sway doctors to prescribe particular drugs, it does show that payments are associated with prescribing approaches.

“It again confirms the prevailing wisdom … that there is a relationship between payments and brand-name prescribing,” said Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who provided guidance on early versions of ProPublica’s analysis. “This feeds into the ongoing conversation about the propriety of these sorts of relationships. Hopefully we’re getting past the point where people will say, ‘Oh, there’s no evidence that these relationships change physicians’ prescribing practices.’”

ProPublica’s analysis provides a great in-depth look at prescriptions and industry payments. Here are six things we learned from the new report:

1. Payments come in all shapes and sizes: Nationwide, three-quarters of those doctors analyzed for the study accepted payments for speaking, consulting, travel, meals, and gifts.

According to ProPublica, the amount of contributions received by doctors could be minimal — such as a free meal — and they would still prescribe more name-brand drugs than their counterparts who were not wined-and-dined or hadn’t received any form of payment.

2. More money means more name-brand prescriptions: Doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty.

Doctors who received more than $5,000 from companies in 2014 typically prescribed the most name-brand prescriptions.

Specifically, the report found that doctors who received more than $5,000 in payments had a name-brand prescribing rate of 30%, compared to the 20% prescription rate for doctors who did not receive any payments from the pharmaceutical and device maker industry.

3. Some specialties affected more than others: Cardiologists receive the most money: Nearly nine in 10 cardiologists who wrote at least 1,000 prescriptions for Medicare patients received payments from a drug or device company in 2014, while seven in 10 internists and family practitioners did, according to the report.

4. State by state: In addition to looking at the national connection between pharma payments and doctors’ prescription habits, ProPublica’s analysis also examined each state, finding a wide variation in those that take industry money.

The rate of payments in Nevada, Alabama, Kentucky, and South Carolina was twice as high as in Vermont, Minnesota, Wisconsin, and Maine.

The state with the highest proportion of doctors who take money was Nevada, with 90%, while the lowest proportion was in Vermont with just 23%.

5. No other option: ProPublica found that while payments from pharmaceutical and device makers do make a difference, doctors also consider a variety of factors when making prescriptions.

For example, some physicians treat patients for issues where there are no generic prescriptions available, like those treating HIV/AIDs patients.

One such doctor tells the Seattle Times there was little linking the $189,000 he received from the industry in 2014 and his high rate of name-brand prescriptions given to patients.

About 55% of his scripts were for name brands in 2014, but they’re mostly for his patients with HIV/AIDS, who have few generic alternatives, he said.

6. It’s better for the patient: Some doctors contend that their prevalence in prescribing name-brand drugs is done in the best interest of patients.

A New Jersey doctor who received $66,800 from companies in 2014 and whose brand-name prescribing rate was more than twice the mean of his peers in internal medicine tells ProPublica he considers the patient’s needs first when making prescriptions.

“I do prefer certain drugs over the others based on the quality of the medication and also the benefits that the patients are going to get,” he said. “My whole vision of practice is to keep the patients out of the hospital.”

Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds [ProPublica]
Confirmed: Doctors who take pharma money twice as likely to prescribe brand-name drugs [The Seattle Times]

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