A new study by researchers at Yale and several other institutions has found that physicians prescribe medicines at a higher rate when they receive payments from the drugs’ manufacturers.

The researchers examined the association between industry payments — which can take the form of compensation for industry-sponsored medical education events, gifts and meals — and prescribing patterns for branded medications. Led by John Barbieri, a postdoctoral researcher at the University of Pennsylvania, the study was published on Oct. 15 in the Journal of General Internal Medicine.

Using data from the Centers for Medicare and Medicaid Services, the team examined whether dermatologists and rheumatologists who received payments from two different manufacturers showed a higher rate of prescription of each of the manufacturers’ branded tumor necrosis factor inhibitor medications — drugs that help treat autoimmune diseases like rheumatoid arthritis.

“Tumor necrosis factor inhibitors are medications that cost tens of thousands of dollars per year. If you think about the potential return on investment of those industry interactions, it could be quite high,” Barbieri said.

The researchers found that larger and higher numbers of payments from manufacturers were indeed associated with increased prescribing of the medications.

This association has both negative and positive implications, according to the authors. Adewole Adamson, a professor of the University of Texas at Austin and co-author of the paper, said that pharmaceutical companies may use industry payments, which can include conferences and information sessions, to improve physicians’ understanding of how to use the medication by giving them more information about the drug’s safety and efficacy.

It is possible that physicians take better care of their patients because of these interactions with the drug manufacturers, Barbier said. At the same time, he added, industry payments could also distort the drug market or influence what physicians prescribe.

Joseph Ross, a professor at the Yale School of Medicine, explained that the most highly promoted drugs are not necessarily the most effective drugs available on the market. Still, some of these new and expensive therapies are very effective drugs for conditions with no other alternative treatment.

Therefore, it is crucial to evaluate whether or not these drugs would be prescribed at such high rates even without the promotion, said Ross, who was not involved in the research.

According to Adamson, the researchers did not investigate whether physicians prescribe certain promoted medicines even when the prescription was unnecessary or inappropriate.

Still, the findings show that physicians are often influenced by industry gestures even when they claim that they are not.

“Most doctors don’t think they are influenced by these dinners or these payments. They feel like they are impartial, but a vast majority of the data suggests the opposite,” Adamson said.

There has been progress within the medical industry to regulate interactions between physicians and pharmaceutical companies. The Sunshine Act of 2010, for example, requires that medical product manufacturers disclose any payments or other transfers of value made to physicians and teaching hospitals.

“Most of [the reform] stems from self-regulation by societies and codes of conduct within medical centers. Most of it has been internally driven, [and] some of it has occurred through a regulatory path, including the Sunshine Act,” said Howard Forman, a professor of diagnostic radiology, economics and public health at Yale and co-author of the paper.

Although the Sunshine Act has been a major step toward increased transparency, Ross said he believes that marketing and promotion should not be permitted, especially to physicians-in-training and medical students. However, he added, a complete ban on industry promotion is unlikely to happen.

Colette Dejong, a resident physician at the University of California, San Francisco, who was also not involved in the research, explained that the U.S. does not have a public system for educating doctors about new medications, unlike in other countries such as the United Kingdom. Industry payments can therefore provide U.S. doctors with the opportunity to learn about new medications in a community setting.

A nationwide ban on industry payments without an appropriate replacement therefore may bring negative unintended consequences, Dejong said.

Further research could examine how the study’s findings can guide future policy, Forman said.

The volume of open industry payments to physicians was $8.40 billion in 2017, according to the Centers for Medicare and Medicaid Services.

Eui Young Kim | euiyoung.kim@yale.edu

Jasmine Su | i-shin.su@yale.edu .