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Pharma Money Dictates What Brand-Name Drugs Doctors Prescribe

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Although there have been speculations about a link between the money that doctors receive from pharmaceutical companies and the drugs they prescribe to patients, there has been little evidence to prove the association - until now.

An analysis by investigative journalism organization ProPublica, together with NPR, found evidence to support the accusation.

The report revealed that doctors who take pharma money indeed give out prescriptions much differently on average than their colleagues who don't.

In fact, the more pharma money they receive, the more brand-name drugs they prescribe, researchers found.

Matching Records

ProPublica researchers examined records on payments from pharmaceutical companies and medical device makers in 2014, and matched them with corresponding information on the prescription of doctors in Medicare's program, which is called Part D. The records from Part D cover more than 39 million people, but the study only accounted to at least 1,000 prescriptions.

The analysis revealed that as the pharma payments increased, the brand-name prescriptions tended to go up as well.

Doctors who received money from drug and device manufacturers prescribed a higher percentage of brand-name drugs overall, researchers said. Even doctors who simply received meals from pharma companies prescribed more brand-name medications.

Those who received $5,000 worth of pharma money in 2014 had the highest brand-name prescription rates. The difference was that internists who did not receive pharma money had a 20 percent rate of brand-name prescription, while those who received more than $5,000 had about 30 percent.

"This feeds into the ongoing conversation about the propriety of these sorts of relationships," said Dr. Aaron Kesselheim of Harvard Medical School, who provided guidance on the early versions of the analysis. "Hopefully we're getting past the point where people will say, 'Oh, there's no evidence that these relationships change physicians' prescribing practices.'"

Widespread Payments

However, the ProPublica analysis does not prove that industry payments persuade doctors to prescribe specific drugs, or even the company's own drugs. Instead, it explains that pharma payments are linked to a prescription approach that benefits drug companies.

Meanwhile, the organization's analysis yielded varying results from state to state when it comes to what proportion of doctors take pharma money. The proportion of those receiving payments in Alabama, Nevada, South Carolina and Kentucky were at least twice as high as in Minnesota, Vermont, Maine and Wisconsin.

Still, the payments are widespread overall.

Nearly 9 in 10 cardiologists across the nation who wrote 1,000 prescriptions for Medicare received pharma money in 2014, while 7 in 10 family practitioners and internists did.

"You have the people who are going out of their way to avoid this, and you've got people who are, I'll say, pretty committed and engaged to creating relationships with pharma," said Dr. Richard Baron of the American Board of Internal Medicine. "If you are out there advocating for something, you are more likely to believe in it yourself and not to disbelieve it."

How Doctors Prescribe Drugs

In their defense, doctors consider many different factors when choosing which to prescribe.

Pharmaceutical Research and Manufacturers of America spokesperson Holly Campbell mentioned a 2011 study that found that 9 in 10 doctors felt that much of their prescriptions were influenced by clinical experience and knowledge.

Campbell said both physicians and pharmaceutical companies work together to make better use of current treatments.

"Physicians provide real-world insights and valuable feedback and advice to inform companies about their medicines to improve patient care," she said.

Dr. Felix Tarm of Kansas prescribes more than twice the rate of brand-name medications compared with internists.

On the verge of retiring, Tarm received $11,700 in payments in 2014. He said he doesn't draw salary from his medical practice, but he subsidizes it with the money he gets from drug companies. He also mentioned that he doesn't own a pharmacy or laboratory, which are often used by doctors to increase their income, he said.

"I generally prescribe on the basis of what I think is the best drug. If the doctor is susceptible to being bought out by a pharmaceutical company, he can just as easily be bought out by other factors," added Tarm.

Photo: Chris Potter | Flickr

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