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Does free food from med reps influence medics to prescribe ?

Posted on 12 months ago by Gerry Kennedy

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The Journal of the American Medical Association lit a fuse in pharma last week with its study of free meals for doctors--the one that associated pharma’s food with increases in brand prescriptions.

Since it published 8 days ago, we’ve seen an explosion of response from industry executives and marketing experts alike. So, we turned to someone who analyzes pharma reps and their doctor meetings for a living: Bill Coyle, a principal with the global sales and marketing firm ZS.

Coyle’s main beef with the JAMA study was this: Because it included data only on free meals--from the government’s Open Payments database, mandated by the Sunshine Act--and Medicare prescriptions, it couldn’t account for other factors that might influence doctors’ decisions.

Reps usually dangle free food as an incentive for physicians to take the time to hear their sales pitches--namely, information on their meds. That might include new data, or for new drugs, a soup-to-nuts explanation of their risks and benefits. Reps might have handed out samples along with the meals, too.

According to ZS’ own data--collected via its work with dozens of biopharma’s biggest companies--free meals are “well correlated with sales force visits to the prescriber, as well as sampling,” Coyle said. Without nitty-gritty detail on sales calls, “the study could ignore the impact of the fact of the rep being there, or about samples,” he added.

The JAMA study did try to control for other factors, but without that actual data, it “probably accrued way too much value” to the meal itself, Coyle said. ZS’ proprietary info shows that samples have more impact on prescribing decisions than free meals do.

The JAMA study found that doctors who reported free meals from sales reps working on the AstraZeneca statin Crestor had higher rates of prescribing Crestor over other statins. The researchers found similar associations with free food and a physician’s rate of Bystolic, Benicar and Pristiq prescribing over other meds in their classes. More meals were associated with higher relative prescribing rates, the study found.

More meals might simply mean more information changed hands, Coyle pointed out, or that more samples were handed out. Plus, the drugs the researchers chose accounted for small percentages of scripts in their classes overall, which might have skewed the numbers, he said.

The JAMA researchers aren’t the only ones to find an association between free meals and increased prescriptions. None of them has been able to prove that the food actually caused doctors to write more scripts, however. “[Is] it that hard to believe that physician gets information that actually compels them to prescribe, or that they’re reminded of that information?” Coyle asked.

Coyle also posed a broader question: Is brand prescribing necessarily a bad thing in itself? Unnecessary use of brands might increase healthcare costs, but there might be good reasons for a doctor to choose Crestor, for instance, over a Lipitor generic. “They might be looking at the JUPITER data,” Coyle suggested.

AstraZeneca’s JUPITER study showed that Crestor cut the risks of heart attack, stroke and medical procedures such as coronary bypass surgery and angioplasty in patients at high risk of heart disease. On the basis of that data, the FDA in 2011 granted Crestor a new indication for primary prevention of heart disease. The JAMA study looked at 2013 prescribing data.

Some studies have shown that sales rep visits and the information conveyed during them can actually benefit patients, Coyle said. ZS published a study in 2012 in the Journal of Clinical Hypertension, showing that doctors who barred sales reps were slower to back away from drugs with new black-box warnings and slower to adopt new standard-of-care recommendations for new meds.

The truth about brand promotion and prescribing is that it may not always be good, but nor it it always bad. “It’s that balance,” Coyle said. From his perspective, the JAMA study came across squarely on the “always bad” side of things. “If you want to believe inappropriate decisions are being made, then you can use this study to help you believe that,” he said.