Pharmaceutical and medical device companies have been known to pay out ‘Big Bucks’ to doctors for prescribing their drugs and medical equipment.

In fact, studies have found that doctor gifts and payments increase the amount of drug prescribing by 73 percent. In 2019, a study published in the journal Addiction showed that physicians who received direct payments from providers for opioid drugs tended to prescribe substantially larger quantities of those drugs, particularly hydrocodone and oxycodone.

According to a recent report by the Centers for Medicare and Medicaid Services (CMS), doctors and hospitals received more money in 2018 from pharmaceutical and medical device manufacturers than they did in 2017.

More than 2,500 physicians have received at least half a million dollars apiece from drug makers and medical device companies in the past five years alone, a new ProPublica analysis of payment data shows. And that doesn’t include money for research or royalties from inventions.

Medical Companies Pay Doctors Big Bucks

The latest data from consumer advocate ProPublica’s “Dollars for Docs” shows that between August 2013 and December 2016, pharmaceutical companies paid doctors over $9 billion for promotional talks, research and consulting, and other “general” items.

Among the highest-paying companies include Genentech, Zimmer Biomet, DePuy, Stryker, AstraZeneca, Pfizer, Allergan, Arthrex, and Janssen. Some of the highest-earning doctors received more than $60 million each.

In 2010, President Barack Obama signed into law the Physician Payments Sunshine Act, which required disclosure of any payment over $10 to medical professionals from pharmaceutical companies, insurance companies, or other providers seeking reimbursements under Medicare, Medicaid, and Children’s Health Insurance Program (CHIP).

Pharmaceutical and medical device companies are required by law to release details of their payments to doctors and U.S. teaching hospitals.

Want to find out if your doctor is receiving money from Pharmaceutical companies, those records are searchable for free on several websites:

• Centers for Medicare & Medicaid Services
• ProPublica’s Dollars for Docs
• Association for Medical Ethics

Prescription Drugs With Top Spending on Doctor Payments

Here are the drugs for which pharmaceutical companies spent the most money paying doctors, per year, excluding research and royalty payments. The list does not include payments to teaching hospitals. Data for 2014-2016 is from a prior release of Dollars for Docs and any subsequent updates are not reflected.

(Credit: Moiz Syed/ProPublica. Source: ProPublica analysis of Open Payments data from the Centers for Medicare and Medicaid Services.)

Based on four different papers, published in The New England Journal of Medicine, the PLoS Medicine, and the Journal of General Internal Medicine, the efforts to curb drug companies’ courting of your doctors is still ineffective.

In fact, the industry is working harder than ever to influence which medicines you are prescribed, by sending out sales representatives with greater frequency, bringing gifts, meals and offering consulting fees to high prescribers.

According to the study published in The New England Journal of Medicine,

• 94 percent of doctors have some type of relationship with the drug industry
• 80 percent of doctors commonly accept free food and drug samples
• One-third of doctors were reimbursed by the drug industry for going to professional meetings or continuing education classes
• 28 percent of doctors have been paid for consulting, giving lectures, or signing their patients up for clinical trials

Contacts between doctors and sales reps have jumped from an average of 4.4 visits per month in 2000, to an average of:

• 16 times per month with cardiologists
• 9-10 times per month with internists
• 8 times per month with pediatricians
• 4 times per month with surgeons

The only group appearing to be meeting drug company representatives less often than before is anesthesiologists, who now see reps twice a month.

Insights

It’s natural to assume when your doctor prescribes a medication, it’s because it’s The Best Choice for your condition, based on research and FDA approval. However, studies have revealed that doctors are often influenced and educated by pharmaceutical companies.

Sadly, these sales tactics are working. In the second PLoS Medicine study, visits by drug sales reps prompted nearly half of 97 doctors to increase their prescriptions for Gabapentin, an anti-seizure drug. In many cases the reps were advocating the use of Gabapentin for non-approved, so-called “off-label” uses.

Although Gabapentin has only been approved by the FDA for seizure control, doctors continue to prescribe it OFF-Label due to drug rep advisement for:

• Peripheral Neuropathy
• Diabetic Neuropathy
• Bipolar Disorder
• Attention Deficit Disorder
• Restless Leg Syndrome
• Neuropathic Pain
• Complex Regional Pain Syndrome
• Trigeminal Neuroalgia

Even worse, this medication has now made it’s way into veterinary practices for the use of general pain and nerve pain for pets. Just last month, I vehemently declined this drug for my cat and had to educate my vet (whom I adore) on it.

The fact is most doctors are not familiar with drug research nor FDA approvals on your medication. Instead, they’re being educated by the pharmaceutical reps who are trying to get their drug into the doctor’s office.

When most doctors have been told by their pharmaceutical rep that this medication is best for a specific condition….they buy into it. As a matter of fact, a study published in the New England Journal of Medicine revealed that most doctors choose which medications to prescribe based on the incentives and gifts (aka – ‘kickbacks’) they receive from Pharmaceutical companies.

The Journal of General Internal Medicine study found that physicians do understand the potential conflicts of interest, with being ‘wooed’ by drug companies but still view their meetings with drug reps as both valuable and appropriate. According to the authors of that study, this proves that the voluntary guidelines currently in place are inadequate.

Resources

1. The New England Journal of Medicine April 26, 2007; 356:1742-1750
2. PLoS Medicine April, 2007; 4(4):e150
3. PLoS Medicine April, 2007; 4(4):e134
4. Journal of General Internal Medicine February, 2007; 22(2): 184–190
5. Washington Post April 28, 2007