Every day in this country, doctors prescribe millions of dollars worth of medications. Should a doctor prescribe a generic medication or a brand name medication which does much the same thing but costs many times more? One way to get a doctor to prescribe a brand name medication is to have the patient ask for it. This is why you are treated to hours of television advertising about medications which the fine print says might cause a heart attack or stroke while treating your (fill in the blank medical condition).
The other tried and true way to get a doctor to prescribe a brand name medicine is for the maker of that medicine to directly influence the doctor. Even a small increase in the number of doctors who prescribe your brand name medication can make a huge difference to your bottom line, if you are a drug manufacturer.
For a number of years now, the Wall Street Journal has been mining Medicare data and looking for relationships. As I mentioned last week, it has written, for example, about urologists who treat prostate cancer patients and the effect that ownership of an expensive x-ray machine has on whether they are more likely to order x-ray treatment of their patients, if they own the machines. Hint: They are. Last week the medical journal JAMA Internal Medicine got into the act. It wanted to know if buying a meal for a doctor made it more likely the doctor would prescribe the brand name medication of the company paying for the meal. Hint: It did.
The authors compared the payments pharmaceutical companies made to doctors with the prescribing patterns of those doctors for three cardiovascular drugs and one anti-depressant, all of which had lower priced alternatives. They used Medicare data for prescriptions for these drugs. Prescribing information is not available for non-Medicare patients. The authors found that even a single, inexpensive meal greatly increased the likelihood that the doctor recipient would prescribe one of the brand name medications. Here is a link to the online article.
No one is suggesting that either the doctors or the manufacturers did anything wrong. There is certainly nothing wrong with a drug manufacturer buying a doctor an inexpensive meal, nor is there anything wrong with a doctor accepting an inexpensive meal. Certainly, no ethical doctor (or probably no unethical doctor either) is going to sell out his or her patients for a cheap meal. What we have here, however, is another example of human nature at work. Even a small gift can create warm, fuzzy feelings which can subconsciously affect prescription patterns. Just another reminder that medicine in the United States is a big business in which billions of dollars change hands each year. Some of the players know more than you and are able to tip the scales. While you cannot know as much as your doctor, it is important for you to know if a brand name is better for you than a lower priced alternative. Ask, research and be informed. You’ll be better off for it.
