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Review of 93 studies raises concerns about how pharmaceutical marketing affects patient care

By Mark Huffman of ConsumerAffairs

• A new Cochrane review links drug company gifts and payments to more prescriptions, less appropriate prescribing and probably higher costs.

• Even inexpensive meals were associated with greater prescribing of the sponsoring companys drugs.

• Policies restricting industry interactions appear to improve prescribing, although the studies cannot establish that gifts caused the changes.

Free meals, gifts and payments from pharmaceutical companies are associated with changes in the medicines doctors prescribe, according to a new review published by the Cochrane Collaboration.

The researchers examined 93 studies, including 82 conducted in the United States. They found that doctors receiving industry gifts and payments wrote more prescriptions and prescribed less appropriately than those with fewer or no such interactions. Prescription costs may have also been higher, the researchers said.

Drug companies promote their products through sales representative visits, sponsored education, meals, travel expenses, consulting fees and payments for serving on advisory boards. Those relationships can steer prescribing toward a companys promoted medicine, which may not be the most suitable or affordable option, Cochrane said.

The findings extended across several drug categories, including medicines for high blood pressure and cholesterol, antidepressants and opioid painkillers. Doctors who received more company-sponsored meals tended to prescribe more of that companys drugs.

Small gifts, meaningful concerns

Lead author Dr. Barbara Mintzes, of the University of Sydney, said physicians often regard free meals as too insignificant to influence their judgment. But the evidence suggests those meals are an effective marketing tool.

Study coauthor Dr. Lisa Bero, of the University of Colorado Anschutz, said the consequences reach beyond spending. She said patients should be offered the most appropriate treatment for their condition, based on clinical evidence not industry marketing.

Cochrane highlighted opioid prescribing as a particularly troubling example: industry payments were associated with a greater likelihood of prescribing dangerously high doses.

Restrictions may help

The review found that conflict-of-interest policies limiting or managing industry interactions probably improve prescribing appropriateness and may reduce prescription volume. Evidence about free drug samples was too uncertain to support firm conclusions.

The researchers cautioned that the studies methods could not establish cause and effect. Even so, the pattern linking greater industry contact with less appropriate prescribing was consistent. The review examined evidence available through January 2025.

Patients interested in their clinicians financial relationships can search the federal governments Open Payments database, which publishes reported payments from drug and medical device companies to healthcare providers. Those records can provide a starting point for a conversation about treatment choices and costs.