Your physician may have any number of degrees, honors, certifications, and other framed pieces of paper mounted to their office walls, but does any of that make them less susceptible to a glad-handing pharmaceutical sales rep who comes armed with some reading materials, free samples, and a lunch charged to their expense account?

Earlier this week, the journal JAMA Internal Medicine published the results of a study on the potential connection between industry-sponsored meals on doctors’ prescribing patterns.

For the study, researchers from the medical schools of the University of California, San Francisco and the University of Hawaii looked at available data from the Centers for Medicare & Medicaid Services’ Open Payments system, which collects data on payments and other transfers of value — including meals — to physicians from a variety of industries, including pharmaceutical companies.

The researchers looked at data for more than 63,000 such payments (95% of which were meals, at an average price tag below $20 each) related to four prescription drugs: cholesterol medication rosuvastatin (aka Crestor); blood pressure med olmesartan; beta-blocker nebivolol; and antidepressant desvenlafaxine (aka Pristique).

For each of the drugs, the researchers found that “Physicians who received a single meal promoting the drug of interest had higher rates of prescribing” that drug, and that “Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.”

However, the study cautions that this data does not prove a cause-and-effect relationship between the gratis grub and increased prescribing of the drugs related to those meals.

In fact, the connection between the free stuff and prescribing patterns could range from being potentially harmful to patients to actually being for their benefit.

The study gives the example of a doctor attending an industry-sponsored event or meal wherein they learn of new information that causes them to begin prescribing — or more frequently prescribe — a medication that is better for their patients. In such a case, the free meal is a net-positive.

On the other end of the spectrum, you could have a physician who bases their prescribing habits on whichever sales rep comes knocking with free pizza. That is, in the words of the study, “cause for concern.”

In the middle are physicians who are fine with taking meals from certain sales reps because they would be prescribing those particular medications regardless. As long as that doctor doesn’t feel restrained from prescribing a better drug that comes along, such a situation could be viewed as ethically neutral.

The researchers, who acknowledge the limited sample size of their data, do believe that their data supports the need for ongoing transparency efforts, especially on small-dollar meals. Additionally, while the Open Payments system includes information on billions of dollars in payments, gifts, and meals, it doesn’t have any data on non-payments like free drug samples and supporting literature, both of which could have an influence on how doctors choose to prescribe drugs to their patients.

In concluding their study, the authors suggest a path forward for continued study of this issue.

“Future research could compare industry-sponsored meals and other methods for disseminating drug information, such as academic detailing and independent drug bulletins, with respect to the cost and quality of prescribing. The methods used in this study could be applied to other payment types, to drugs with varying degrees of generic competition and cost- effectiveness, and to brand-name drugs that compete within the same class.”

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