A new Cochrane review strengthens the case for getting drug company marketing out of the exam room and restoring independent medical judgment.
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THE TOPLINE
- A Cochrane review of 93 studies associated gifts and payments to doctors with more prescribing and less appropriate prescribing.
- Even gifts as small as company-sponsored meals were associated with more prescriptions for sponsors’ drugs, including opioids.
- Stronger limits on industry interactions may improve prescribing and help protect discussions of all appropriate options, including natural and preventive approaches.
When your doctor recommends a medication, you should be able to trust that the recommendation reflects your health needs. But a new review raises a disturbing question: how much influence does the company selling that medication have over the person prescribing it?
A Cochrane review published October 9 examined 93 studies, including 82 from the United States. Its findings reinforce a concern ANH has raised for years: pharmaceutical marketing is associated with prescribing that serves drug company interests at patients’ expense.
The clearest evidence concerned gifts and payments. Doctors receiving them prescribed more medicines and prescribed less appropriately. Advertising and industry education, including sales representative visits, were also linked to more prescribing.
The Influence Can Start with Lunch
The review’s accompanying announcement describes a marketing apparatus that reaches into everyday medical practice: meals, travel expenses, consulting fees, advisory board payments, and visits from sales representatives.
Doctors may believe a free lunch is too trivial to influence their judgment. The evidence gives patients reason to question that confidence. Researchers found a consistent pattern linking more company-sponsored meals to more prescribing of the sponsor’s medicines, across several drug classes.
The opioid findings were particularly troubling. Even inexpensive meals were associated with increased opioid prescribing, while larger payments were linked to a greater likelihood of prescribing dangerously high doses.
Almost all the studies were observational, so they cannot establish that marketing caused the prescribing changes. The review also calls for more research on actual patient health outcomes. But those limitations do not erase the consistent associations it identified. Patients deserve safeguards against influences that can compromise their care.
A Longstanding Problem Across Medicine
ANH has been reporting on pharmaceutical influence for many years, including concerns about industry relationships with researchers and the role of drug company money in medical education.
In 2015, we highlighted federal Open Payments data showing $6.49 billion in payments from drug and device manufacturers to doctors and hospitals in 2014. That total included research payments; it was not a tally of promotional gifts alone. Still, it revealed the enormous financial ties connecting manufacturers with the institutions and professionals patients rely on.
Our 2016 coverage of the American Academy of Pediatrics raised questions about industry funding of professional organizations and the independence of their policy positions. More recently, we examined pharmaceutical funding of patient advocacy groups and the conflicts created when organizations representing patients receive money from companies selling their treatments.
What Gets Left Out of The Conversation
For ANH, this raises a broader concern: whose priorities shape the options patients are offered?
A drug manufacturer has a commercial reason to promote its own products, and that promotion is clearly paying dividends. There is no comparable market force driving doctors to discuss non-pharmaceutical interventions such as nutrition, physical activity, trauma therapy, social or nature prescribing, or any of the dozens of other non-drug approaches that may be scientifically and medically valid for addressing a patient’s needs. Doctors are not getting lunch bought for them by Big Salad. Our concern is about a system in which companies selling medicines have routine access to the professionals deciding which medicines patients receive.
Patients need independent evaluation of all appropriate options, including natural and preventive approaches, with honest discussion of benefits, risks, costs, and uncertainties. Commercial influence makes that independence harder to protect.
Another source of the problem is something we’ve discussed for years: most doctors lack training in nutrition and lifestyle medicine. It’s why we support RFK Jr.’s drive to increase nutritional education in medical schools.
Patients should ask practical questions in the doctor’s office: Why this medicine? Is there a safer or less expensive alternative? What non-drug options are appropriate? And now, the following questions should be added: Do you receive payments from the manufacturer of the drug you’re recommending I take?
Medical decisions should put patients’ health, their needs, and their right to informed choices first. This review gives medical institutions another reason to stop treating pharmaceutical promotion as an ordinary, harmless part of patient care.
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