A recent article published by JAMA found pharmaceutical industry-sponsored meals valued at less than $20 were associated with higher rates of prescribing certain brand name medications. But is it fair to call this bribery and call it a day?
Before assuming physicians are readily selling out their patients for the price of a sandwich, consider the following points raised in a recent Bloomberg View report.
1. The study's design doesn't account for reverse causation. In other words, it's possible that pharmaceutical reps were treating physicians who already prescribed more of their drugs. Those physicians would be more interested in attending industry-sponsored events regarding that medication.
2. The study doesn't define a "right" rate at which physicians prescribe the specified drugs. According to Bloomberg, we should question the assumption that physicians who did not accept industry-sponsored meals prescribed the "right" amount of the drugs, and that "any deviation from this prescribing behavior represents an unjustified bias," according to the report. It is reasonable to argue physicians who took the time to meet with pharmaceutical sales reps for lunch learned important information about new drugs that could benefit their patients, and that they would not have otherwise learned if they declined the offer.
3. The study does not identify the mechanism of action. While the association between industry-sponsored meals and higher rates of prescribing certain drugs may exist, the study doesn't say precisely what accounts for the increased prescriptions. Importantly, the notion that a straight bribe is driving more prescriptions does not seem to be a likely explanation of the behavior. According to the report, it seems implausible that physicians, some of whom may make $400,000 a year, would think to themselves: "Sure, this brand-name prescription is probably completely unnecessary, but if I stop prescribing it, who will buy my next ham on rye?"
4. The compulsion to reciprocate probably does exist, however. Despite the low value of industry-sponsored meals — the average cost of a meal in the study ranged from $12 to $18 — gifting physicians anything could trigger the human instinct to reciprocate by increasing prescriptions for a certain drug, according to the report.
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