JAMA's Pizza Principle

  • by: Peter Pitts |
  • 08/30/2016
From today’s edition of the Detroit News

Doctor-industry lunches are good for you

Drug firms have discovered a powerful new mind-control technology that threatens to topple our healthcare system: a free slice of pizza. That’s the implication — but not the actual findings — of a new study in JAMA Internal Medicine.

The report finds that physicians who accept complimentary meals of under $20 in value from pharmaceutical representatives are more likely to prescribe certain brand-name medications to Medicare patients. The more frequent — and more expensive — the meals, the greater the effect on doctors’ prescribing rates.

Is the drug industry corrupting America’s medical practitioners through a cunning use of appetizers? Not quite. The study fails to mention that doctors voluntarily attend these meetings to stay informed about new medicines — not new recipes.

What’s more, the article never bothers to ask a basic question: are doctor-industry interactions bad for the health of patients? To date, there is no evidence to suggest that they are.

In reality, meals are often provided as part of educational events hosted by drug companies. The point of these meetings is to convey technical information to doctors about a particular drug. Doctors who attend the meeting and learn about a medicine’s clinical effectiveness are obviously more likely to prescribe that drug than physicians who didn’t go to the meeting and have never heard of the medicine. Similarly, doctors who already prescribe a company’s medicine are more likely to receive lunch invites than doctors who aren’t in sales reps’ rolodexes.

In other words, it’s hardly surprising or scandalous that doctors who meet with salespeople are more likely to use what they’re selling — once they’ve learned about the value of the medicines being discussed.

Complaints about drug-company influence would be a lot more credible if researchers could show it harmed patients’ well-being. For instance, do free meals compel doctors to prescribe a brand-name drug when a cheaper generic would suffice? Do they persuade physicians to use one particular treatment when a different therapy would be more effective?

There’s simply no way for physicians to stay current on every pharmaceutical product at their disposal. By one estimate, some 1,700 articles are published on the top 25 medicines each year. Drug producers use a variety of promotional efforts to cut through this information glut.

Dennis Ausiello, chief of medicine at Massachusetts General Hospital, and Thomas Stossel, a professor at Harvard Medical School, have made this point. According to them, “company salespersons complement physicians’ information derived from many sources. They tell physicians about a limited range of products about which their employers train them under strict FDA regulations.”

Since when did transmitting accurate medical information to doctors become a bad thing?

To be sure, pharmaceutical firms are motivated by profit. But improving patient health and boosting sales aren’t mutually exclusive ends — especially when the product in question addresses a genuine public health need.

Moreover, it’s simplistic and insulting to assume that highly-educated doctors are selling out their patients for the price of a slice. In a 2008 survey of physicians conducted by KRC Research, only 11 percent reported being greatly influenced by pharmaceutical representatives. Clinical knowledge, a patient’s specific circumstances, and insurance restrictions all played a larger role in determining prescribing practices.

Let’s hope misinterpreted studies and manufactured media outrage don’t lead to further restrictions on these meetings. If that were to happen, doctors might go without a free lunch — but patients would go without the best treatment plans possible.

Peter Pitts, a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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