The effect of free meal payments on medical prescribing.
Regular readers will know that I have posted several times on the band of orthodontic KOLs who
promote certain orthodontic products. However, I have not looked at the effect of other industry payments on practitioners’ practices. This post is about two papers that investigated this subject in medicine.
We are all familiar with the orthodontic suppliers providing entertainment in the form of meals and other payments. . Furthermore, we participate in industry-sponsored conferences and other events. We need to consider whether this influences our treatment. There has been no research on this in orthodontics.
However,there have been several studies looking at this in medicine. I thought that I should have a quick look at two of these studies.
A Californian and Hawaii based team did this study. The Journal of the American Medical
Association published the paper.
They based this research on the concept that industry-sponsored meals and payments may influence prescribing behaviour.
What did they ask?
They asked this straightforward question;
“Is there an association between physicians receipt of industry-sponsored meals and prescription rates”?
What did they do?
They did a cross-sectional study. In the first stage, they obtained information on prescription patterns from Medicare of four commonly used drugs. These included statins, beta-blockers and ACE inhibitors. These drugs all had generic, cheaper alternatives.
Then they used the Open Payments database to identify payments promoting the drugs to the selected physicians. The primary exposure of interest was industry-sponsored events.
The Open Payments database is a source of information on all the payments made by industry to medical and dental care providers in the United States. You can find it here.
Finally, they ran multivariate analyses across the data to identify predictors of prescription.
What did they find?
They looked at data from 280,000 physicians and 63,000 payments. 95% of these were for sponsored meals.
Their detailed statistical analysis showed that physicians who received payments were associated with increased prescription of brand name drugs compared to cheaper generic versions.
They pointed out that the association was not causation.
The other paper used a similar methodology.
Manvi Sharma et al
Sharma et al. BMC Health Services Research (2018) 18:236
A team from Texas did this study.
What did they ask?
“Is there an association between payments made to physicians and prescription of costly brand name drugs”?
What did they do?
They did a retrospective cross-sectional study. Again, they used the Open Payments database and a Medicare source for prescription practices. They identified six brand name drugs with cheaper generic drugs.
What did they find?
They analysed data from 837,000 prescribers. Importantly, 38% received at least one payment from a pharmaceutical company. Interestingly, their findings were similar to the previous study. They concluded that;
“A physician’s industry financial payments were associated with increased odds of prescribing costly brand name drugs over cheaper generic drugs”.
What did I think?
Firstly, I thought these were two interesting papers. When I considered the shortcomings of the research, the most critical factor was that these were retrospective studies. However, the investigators had interrogated established databases. Nevertheless, the contents were outwith their control, and there is a possibility of inaccuracies.
Importantly, we also need to remember that association is not causation.
There have also been several other studies looking at this question, and they reached the same conclusion. Payment (even meals) influences prescribing practices.
Is this relevant to orthodontics?
Firstly, we have to consider if there is a problem concerning our company colleagues promoting their products via advertising. There is nothing wrong with this approach. This is because clinicians can evaluate the evidence on any new development.
However, this becomes a little unclear when We consider the effects of being entertained by a company. Many of us will have experienced entertainment. It varies from being invited to meals, the lunchtime pizza event and the industry-sponsored conference.
I think that this only becomes a problem when we use the promoted products and charge more or make claims that are not supported by any research. Unfortunately, this happened with self-ligation, vibration and a seemingly endless list of magic developments.
I also wonder if this becomes more marked when clinicians attend industry-sponsored meetings. At these events, clinical salespeople (KOLs) promote products. I could not help feeling that this is particularly relevant at the moment where HSO and Align have sponsored several sessions at the PCSO meeting, and 3 of their clinical salespeople are speaking.
I think that the editor of JAMA in their comments made a fascinating comment when they stated;
“If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off”.
Finally, this all goes back to self-declaration. Should a clinician declare that they received a payment from a company to their patients when they prescribe a new bracket or device which is more costly than others? This has been suggested for medicine. Let us have a discussion?
Emeritus Professor of Orthodontics, University of Manchester, UK.