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Doctors With Strong Financial Ties To Pharma Are Found More Likely To Prescribe Brand-Name Drugs

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Generic cholesterol pills are probably better for most patients than brand-name medications because the lower cost of generics increases the chance the patients will take the pills every day.

Yet some physicians primarily prescribe expensive brand-name drugs like Lipitor and Crestor. According to a recent study of physicians in Massachusetts, about a quarter of cholesterol prescriptions are for brand name drugs:

JAMA Internal Medicine

Why are physicians so enthusiastic about prescription drugs? For starters, some patients may have taken generic drugs already without achieving adequate cholesterol reduction or, perhaps, with side effects. In addition, some patients may prefer brand names over generics and request them from their physicians. Some physicians, too, might prefer brand-name drugs, perhaps because of advertising.

Or is it because they have gotten financially entangled with the pharmaceutical industry in ways that cloud their clinical judgment? That’s a possibility posed by a research team out of Harvard. The team evaluated the percentage of brand-name cholesterol pills physicians prescribed, as a function of how much money the physicians made through interactions with the pharmaceutical industry.

Here's a picture of those results, which shows a few things:

  1. Most physicians take little or no money from pharma.
  2. A small number of doctors take a whole lot of money — hundreds of thousands of dollars.
  3. The stronger a physician’s financial relationship with industry, the more likely that physician will be to prescribe expensive brand-name cholesterol pills.

JAMA Internal Medicine

Now for a whole lot of cautions.

First, correlation does not equal causation. The relationship shown in this figure — between prescribing patterns and pharmaceutical money — could be a coincidence. It could even be reverse causation — the pharmaceutical company may identify high prescribers and then enter into financial relationships with them. There could be some other, unmeasured factor influencing both prescribing patterns and industry relationships. In other words, this analysis does not prove that industry money is causing physicians to prescribe unnecessarily expensive medications.

Second, the statistical association shown in this picture is being driven by a small number of physicians. Out of almost 2,500 physicians included in the study, it was a couple dozen who drove the association.

Third, the researchers looked at the money physicians made interacting with the pharmaceutical industry, not just the money they made from cholesterol pill manufacturers.

So what’s the bottom line here?

Well, we should be happy that brand-name cholesterol pills made up less than a quarter of prescriptions; we are making progress in reducing wasteful prescribing. We should also be happy that most physicians are not deriving substantial portions of their income from the pharmaceutical industry. And finally, we should remember that even when physicians have legitimate reasons to work closely with the pharmaceutical industry — we want good doctors to help the industry develop good medicines — they should not let those relationships influence their prescribing.

Physicians deserve to be reimbursed for the time they spend helping the pharmaceutical industry develop products.  And patients deserve to know that their doctors don’t let such reimbursement cause them to prescribe unnecessarily expensive medications.