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 Each year in the U.S., $73 billion is spent on brand name drugs for
which there is an equivalent generic available, and patients pay for
$24 billion of that amount themselves, said senior author Dr. R.
Adams Dudley of the University of California, San Francisco.
“That’s an awful lot of money,” Dudley told Reuters Health by phone.
The brand name drugs and the generics are “so similar that there’s
no benefit,” from using the brand name versions, he said.
Dudley’s team analyzed industry payment data from late 2013 and
prescribing data for that year from doctors treating Medicare
patients with common drugs for heart problems or depression.
For each class of drug, the researchers chose the most prescribed
brand name. For the heart drugs, they chose Crestor (known
generically as rosuvastatin) to represent the statins, Bystolic (nebivolol)
for the beta-blockers, and Benicar (olmesartan) for angiotensin-converting
enzyme inhibitors, or ACE inhibitors. They chose Pristiq (desvenlafaxine)
to represent antidepressants known as selective serotonin and
serotonin-norepinephrine reuptake inhibitors (SNRIs).
National organizations in the U.S. and U.K. have deemed these
brand-name drugs to be no better than their generic forms, Dudley
said.
Almost 280,000 doctors received a total of more than 60,000 payments
associated with the four target drugs. The vast majority of the
payments - 95 percent – were in the form of sponsored meals, on
average less than $20 each.
Almost 9 percent of statin prescriptions were rosuvastatin. The
other drugs in the study were prescribed less often.
But doctors who received even one sponsored meal from one of the
pharmaceutical companies were more likely to prescribe the target
drug over a generic alternative, compared to doctors who did not
receive sponsored meals. As the number of meals and meal value
increased, relative prescribing rates also increased, according to a
report in JAMA Internal Medicine.
“Payments for food and beverages are by the far the most frequent
type of industry payments to physicians in the United States,
totaling about $225 million in 2014, the most recent year for which
data are available,” said Dr. Robert Steinbrook, an editor at JAMA
Internal Medicine and a professor at Yale University School of
Medicine.
“Recent research, including the new study being published in JAMA
Internal Medicine, has convincingly shown an association between
industry payments to physicians and the prescribing of brand-name
drugs,” Steinbrook said by email.
A 30 day supply of rosuvastatin costs about $250, while a generic
drug in the same class may cost $150 or less.
“You should ask your doctor, is there a generic that’s just as good
whenever you start a new medicine,” Dudley said.
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It’s not clear from this study whether receiving meals caused
doctors to change their prescribing patterns, but “humans are very
responsive to gifts,” he said. “Normal human behavior is
reciprocity.”
Often a pharmaceutical salesperson will give a doctor a presentation
about a new or existing drug and offer to do so over a free lunch,
or snacks, and doctors are more likely to listen to their pitch if
they can eat lunch at the same time, Dudley said. The salesperson
then focus on the positive aspects of the drug they promote, rather
than talking about how it has no benefit over generic.
This is sometimes a doctor’s only means of learning about new
pharmaceutical developments, at least in the U.S., Dudley said.
“If we’re going to spend $75 billion on this, you can think of
better educational approaches,” without commercial interest, he
said.
Single-payer healthcare systems can negotiate the price of drugs,
and negotiate lower prices for ones without proven benefit over
existing options, Dudley said.
The American Medical Association limits physician “gifts” to
$100 or less, and many academic medical centers now don’t allow drug
reps on the premises.
“At UCSF they can’t even give us free samples, Kaiser doesn’t let
drug reps in, for instance,” Dudley said. “Even without laws some
organizations are responding.”
“(Pharmaceutical industry) promotional events are usually perfectly
legal and acceptable to many physicians; otherwise physicians would
not be attending,” Steinbrook told Reuters Health.
“But in the big picture, physicians have to ask themselves why they
are accepting this largesse?” he said. “We should be advocating for
drug and device manufacturers to spend less on promoting their
products and more on independent bona fide research on safety,
effectiveness and affordability.”
SOURCE: http://bit.ly/28JfcMO JAMA Internal Medicine, online June
20, 2016.
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