Paying Doctors to Prescribe

Perhaps it seemed of little consequence to the doctor at the time.  A simple lunch to learn about the latest prescription pain killer medication on the market.  Later it was a fee to speak at a conference about the use of that drug at the doctor’s practice.  Six months later it was an all-expenses paid trip to a conference put on by the drug manufacturer to further market the medication.  These situations have become common place in medicine and these payments are a major component of drug companies marketing agendas.   So common, in fact, that the Washington Post highlights a new study that “found 434,754 payments totaling $39.7 million to 67,507 physicians — about one in every 12 doctors.” Alarmingly, a subset of this study found that “one in every five family physicians had received this kind of marketing.”

The payments have consequences.  A recent, first of its kind study from doctors and researchers at Boston Medical Center and New York University School of Medicine, found a direct correlation between drug company payments to doctors and overdose deaths associated with the opioid epidemic.  Michael Barnett, a professor at the Harvard School of Public Health who concentrates his research on the correlation between physicians and the opioid epidemic told the Post that these findings are “deeply concerning for the raging [opioid] crisis that we’re all quite aware of.”

Prescription drug representatives (commonly referred to as “drug reps”) have long been a staple at doctors’ offices.  On the one hand, drug reps serve a legitimate purpose in the medical field.  Their role can be seen as a way for drug companies to talk directly with doctors about their product and how it might be beneficial to a physician’s patients. However, in the last two decades, the role of these drug reps has not been limited to education.  The process, which the Post refers to as “detailing,” became a way for drug companies to independently reward or even pay doctors who continuously prescribed the drugs the company was marketing.

There are very few legal restrictions or limits on this marketing.  The result is alarming.  This past spring, researchers at Harvard, in conjunction with CNN, released a study directly showing that doctors who prescribed more opioids received more payments from drug companies.  Patients, rarely, if ever, are informed as to how much money their physician is receiving for prescribing a particular drug.

This process is part of the larger, interconnected web of the opioid epidemic.  For years, drug companies manufactured highly addictive, yet highly profitable painkillers, and utilized drug reps and detailing as a primary method of getting these drugs to the market.  These drugs, such as OxyCotin or Norco, were massively overprescribed, and prescriptions further ballooned as patients became desperately addicted to the drug. Companies, like Purdue Pharmaceuticals, made billions of dollars.  The government responded by attempting to regulate these drugs without a plan to help addicted patients who were forced to either get these drugs for inflated prices on the black market or switch to other, more dangerous and illegal drugs such as heroin to fuel their addiction.  Overdoses sky-rocketed and an epidemic was declared.

The recent study looked at two years’ worth of data and examined overdose deaths in every county in the country.  The researchers then compared this information “with payments to doctors for meals, speaking, consulting and travel” in the time period immediately preceding the overdose data.  The research showed that in counties where doctors received higher payments from drug companies, these same counties “subsequently experienced elevated mortality” from drug overdoses in the years immediately following the increase in payments.

The study’s authors recommend that the best way to reduce the number of overdose deaths or prevent other adverse reactions is to both regulate and reduce the amount of legally permissible physician marketing; i.e., detailing. The Post notes that in 2017, New Jersey implemented a law capping the amount of marketing money physicians can receive from drug companies.  As patients, we can play a role too.  Ask your doctor or local health network what their policy is towards permitting drug reps to pay or otherwise compensate physicians.  Demand that your local health network bans the practice of allowing drug reps to treat or pay physicians and instead, restrict their role to solely providing education information in group settings.