Pharmaceutical corporations — who really decides what you get prescribed?

Aim of the study: There is controversy over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend large sums of money each year promoting their products to them through gifts, free meals, travel subsidies, sponsored teaching, and symposia.

Results: The current extent of interactions between physicians and industry appears to affect prescribing and professional behavior and should be addressed further through policy and education.

Aim of the study: Pharmaceutical companies spend large amounts of money promoting their products to physicians. There is evidence that physicians’ interactions with pharmaceutical companies negatively affect their prescribing patterns. The objective of this study was to systematically review the extent of the relationship between physicians and pharmaceutical companies in low- and middle-income countries (LMICs).

Results: We included 11 eligible studies (7 quantitative and 4 qualitative). Quantitative studies found that pharmaceutical company representatives visited at least 90% of physicians. Printed materials, stationery, and drug samples were the most frequently received gifts. Two studies assessing direct payments found rates of 16 and 5%, respectively. The findings of the qualitative studies were consistent with those of the quantitative studies. In addition, they revealed a growing tendency for pharmaceutical companies to provide expensive personal gifts, sponsor social events, and offer cash inducements to physicians based on their demands. They also identified building personal relationships, creating a sense of indebtedness, and emotional blackmail as commonly used techniques to influence physicians. A relatively high percentage of physicians in LMICs interact with pharmaceutical companies.

Aim of the study: To evaluate the association between industry payments to physicians related to poly (ADP-ribose) polymerase inhibitors (PARPis) and physicians’ prescribing behaviors for PARPis.

Results: Of the 1,686 eligible physician prescribers, 68.7% received one or more non-research payments related to any of the three PARPis from the manufacturers between 2017 and 2021. Median annual payments per physician were $57 for olaparib, $39 for rucaparib, and $62 for niraparib. Receipt of payments for each PARPi was associated with higher odds of prescribing olaparib (odds ratio [OR]: 1.30 [95% CI: 1.14-1.48], p < 0.001), rucaparib (OR: 2.07 [95% CI: 1.58-2.72], p < 0.001), and niraparib (OR: 1.49 [95% CI: 1.22-1.81], p < 0.001). Dose-response effects were observed between the number of annual payments and the number of prescriptions and/or Medicare expenditures for olaparib and rucaparib. Non-research payments from manufacturers to physicians who prescribe PARP inhibitors were significantly associated with increased prescriptions and Medicare expenditures for olaparib and rucaparib in the United States.

Aim of the study: The pharmaceutical industry spends billions of dollars every year marketing its products to US healthcare providers. This study investigates the association between industry marketing payments and physicians’ prescriptions in New York and Massachusetts, and examines how Massachusetts’ payment restriction policy affects this association compared with New York State, which has no payment restriction policy.

Results: Moreover, FE and FD models show that, compared with physicians in NYS, the association of industry payments with days’ supply and costs of Medicare Part D prescriptions was (0.01%-0.02%) smaller for physicians in MA. Because of the smaller sample size and lower statistical power, the LFD model did not detect a significant difference between providers in NYS and MA. The findings of this study provide further evidence that industry payments are associated with increases in the volume and cost of Medicare prescriptions. They also provide preliminary evidence that payment restriction policies weaken this association, which calls for further research.

Aim of the study: Payments to physicians by the pharmaceutical industry are common, but recent evidence shows that these payments influence physicians’ prescribing behavior, including increased prescribing of brand-name drugs, expensive and low-cost drugs, and drugs made by the paying company. Given that these payments increase drug costs for patients and health systems, there is public interest in controlling them.

Results: The search retrieved 579 articles, of which 44 were found suitable for the final analysis. Twenty-nine interventions and strategies were identified, leading to five policy options: prohibition, restriction, physician self-regulation, voluntary industry disclosure, and mandatory industry disclosure. The policies proposed in our study include advantages, challenges, and implementation considerations based on current evidence that can help policymakers manage conflicts of interest (COI) in interactions between physicians and the pharmaceutical industry in Iran’s health system. A combination of measures seems helpful for managing COI: first, engaging physicians and industry in self-regulation to establish transparency, and then implementing mandatory industry disclosure policies and introducing restrictions on some financial interactions.

Aim of the study: Because of sanitary restrictions resulting from the COVID-19 pandemic, various interactions between the pharmaceutical industry and physicians have changed. One of these changes has been the way medicinal products are promoted through academic meetings focused on diseases of commercial interest.

Results: One of these changes has been the way medicinal products are promoted through academic meetings focused on diseases of commercial interest. A recent approach has been unilateral promotion by the pharmaceutical industry through academic events featuring so-called “experts” invited to promote a specific drug. These meetings are often biased, focusing not on optimal care for a disease but on commercial promotion of a specific drug, which may or may not be the best option, without considering related treatment alternatives. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine analyzes this new situation and proposes some considerations for the medical community.

Aim of the study: The Centers for Medicare & Medicaid Services (CMS) Open Payments public database, established under the Physician Payments Sunshine Act of 2010, was designed to increase transparency around physicians’ financial relationships with pharmaceutical manufacturers. We compared physicians’ conflict-of-interest (COI) disclosures in journal articles with this database to identify discrepancies in reported disclosures.

Results: We reviewed 3,465 authorship positions (1,932 unique authors) in 1,770 articles. Within this sample, 7.1% of authorships had a recorded undisclosed COI (a disclosure discrepancy), and 13.2% of articles had first and/or last authors with a disclosure discrepancy. We also saw considerable variation in the percentage of authorships with disclosure discrepancies across journals (JBJS, 2.3%; JOA, 3.6%; and FAI, 23.7%). Discrepancies exist between payment disclosures made by authors and those published in the CMS Open Payments database. Although the percentage of articles with these discrepancies varied widely among the journals analyzed in this study, no trend was found in the number of discrepancies over the 3-year period.

Aim of the study: Interactions between cancer physicians and the pharmaceutical industry may create conflicts of interest that can adversely affect patient care. We aimed to survey cancer physicians about their attitudes toward and interactions with industry.

Results: There were 116 responses (94 complete). Almost half (n = 53 of 115, 46.1%) felt there was a positive relationship between cancer physicians and industry. Most (n = 79 of 104, 76.0%) interacted with industry at least once a month, and 67.7% (n = 63 of 93) had previously received non-research payments from industry, with a median value of 2,000 Australian dollars over 1 year. Most respondents believed that interactions could influence prescribing while simultaneously denying that their own prescribing was influenced (n = 66 of 94, 70.2%). Those who considered general interactions with sales representatives (odds ratio [OR] 9.37 [95% CI, 1.05 to 83.41], P = .045) or clinician sponsorship (OR 3.22 [95% CI, 1.01 to 10.30], P = .049) more acceptable also met with sales representatives more frequently.

Aim of the study: Canada lags behind when it comes to transparency about transfers of value between the pharmaceutical industry and physicians and patient groups. In most high-income countries, transparency is mandated by the government or required for membership in industry associations.

Results: In most high-income countries, transparency is mandated by the government or required for membership in industry associations. Apart from one attempt by a previous Ontario Liberal government, provincial and federal governments have steered clear of this issue, and the role of Innovative Medicines Canada has been minimal. There is evidence that receiving payments is associated with actions by physicians and patient groups that benefit the pharmaceutical industry. Companies should be required to disclose the payments they make.

Aim of the study: Conflicts of interest (COI) between physicians and for-profit companies have existed for centuries, but their visibility has increased dramatically over the last decade through the Centers for Medicare and Medicaid Services’ Open Payments database.

Results: The authors review evidence linking interactions with industry during medical training to favorable views of pharmaceutical marketing, a greater likelihood of continued engagement with industry, and increased prescribing of promoted drugs and devices. They argue that medical schools and their governing bodies must adopt and enforce meaningful COI policies that meet, at a minimum, the existing recommendations of the Association of American Medical Colleges. They further recommend that the Liaison Committee on Medical Education require compliance with these policies for annual accreditation, that research curricula address the influence of funding sources on study design, and that the Open Payments database be incorporated into medical training as a transparency tool. Strengthening COI education and policy is essential to ensure that the next generation of physicians learns in environments where patient-centered, evidence-based medicine guides decision-making.