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One Nice Meal Can Change a Doctor’s Prescribing Habits

Big pharma’s hidden path to doctors’ pens: through their stomachs.

By Francie Diep


(Photo: Benjamin Horn/Flickr)

Sometimes, it’s the little things that count.

Doctors who eat even one meal provided by a pharmaceutical company representative are more likely to prescribe the representative’s drug, according to a new study.

For the four drugs the study analyzed, doctors who received one day’s worth of meals prescribed the target drug anywhere from 18 percent to 218 percent more often than their peers who didn’t get any paid meals. And more meals were associated with more prescribing.

“These are drugs where we’re really sure there’s no quality problem for the patient if you used the generic instead,” says Adams Dudley, a pulmonologist who studies health policy at the University of California-San Francisco and the senior researcher on the study. Dudley and his team examined common classes of medicines for high blood pressure, high cholesterol, heart disease, and depression. “There are so many equivalent generics [for the four drugs in the study], it’s hard to argue for the name-brand on a clinical basis, and it’s easy to argue against from the standpoint of what it costs the patient and what it costs the insurance company and Medicare,” Dudley says.

Most brand-name medicines have a generic equivalent. Research has found generics work as well as brand-name drugs for most, and that people tend to be equally satisfied with them.

The cost of brand-name drugs “dominates” Medicare spending, as National Public Radio reported last year. It can make up a big part of individual patients’ budgets. Last year, in Medicare, the median co-pay for preferred generic drugs was only $1. For preferred, brand-name drugs, it was $38 — and $80 for non-preferred brand names.

“If you go in with gifts, it’s just human nature to be willing to be more reciprocal.”

This new study can’t tell whether paid meals caused doctors to prescribe certain drugs more often, though Dudley offers a hypothesis for how a $15 sandwich might alter a doctor’s prescribing patterns. Pharmaceutical representatives typically come into a doctor’s office during normal business hours, bringing their pastry spread or bagel tray with them, he says. The food encourages doctors to come into the conference room, grab a bite, and listen to what the rep has to say about her or his new drug. “If you go in with gifts, it’s just human nature to be willing to be more reciprocal,” Dudley says. If the rep’s pitch sticks, the doctor may end up writing more prescriptions.

It’s possible other mechanisms are at work, or that meals aren’t causally related to prescribing at all. But Dudley and his team’s study jibes with past research that links gifts from pharmaceutical company representatives to an uptick in brand-name drug prescribing.

Earlier this year, ProPublica published an investigation finding doctors who received large payments from drug companies, such as speaking fees and paid travel, are more likely to prescribe brand-name drugs in general. Dudley’s study, published today in JAMA Internal Medicine, adds to the picture in a finer-grained way.

How can policymakers make sure gifts don’t unduly influence doctors’ prescribing decisions? Some hospitals already forbid pharmaceutical reps from offering free food. More hospitals — and smaller doctors’ offices — could follow suit.

As things stand now, company reps are the primary means for doctors to learn about new drugs, says Colette DeJong, a medical student at UCSF who’s an author on the new study. Another entity, such as a government agency, should take over that responsibility, DeJong and Dudley think. They believe whoever does it will likely spend much less than the societal costs of unnecessary brand-name drugs.

Recent research has made it clear that big gifts influence how doctors practice medicine. This study shows the little things matter too. “The vast majority of prescribers aren’t getting speaking fees. They’re just getting meals. It’s the main way that doctors are interacting with pharmaceutical reps,” DeJong says. “That’s part of why we focused on such small payments in this paper.”