Drug company gifts influence Doctors’ prescriptions, push up healthcare costs – Study

Gifts, free meals and payments from pharmaceutical companies are influencing doctors’ prescribing decisions, encouraging the use of less appropriate medicines and increasing healthcare costs, a major review of 93 studies has found.

The review, published on October 9 in the Cochrane Database of Systematic Reviews, also found that policies restricting interactions between pharmaceutical companies and healthcare professionals were associated with more appropriate prescribing and potentially fewer prescriptions.

Researchers warned that industry-driven prescribing could expose patients to medicines offering limited benefits, unnecessary treatments and drugs with potentially harmful side effects.

“Overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive,” said Dr. Lisa Bero, co-author of the review and affiliate professor at the University of Colorado Anschutz Center of Bioethics and Humanities.

The international research team examined evidence from real-world prescribing practices involving millions of doctors exposed to pharmaceutical marketing, including sales representative visits, advertisements, sponsored educational activities, gifts and financial payments.

Of the 93 studies reviewed, 82 were conducted in the United States, while 11 came from the United Kingdom and Europe.

The strongest evidence concerned gifts and payments, which researchers found were associated with less appropriate prescribing and higher prescription volumes. These promotional activities probably also increased prescribing costs.

Dr. Barbara Mintzes, the study’s lead author from the University of Sydney, said doctors often underestimate the influence of seemingly insignificant gifts, particularly free meals.

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She noted that the evidence showed a relationship between the number of meals doctors received from pharmaceutical companies and the likelihood of prescribing less appropriate or more expensive medicines.

One study found that doctors prescribed 9.3 per cent more opioids for every additional meal they received from pharmaceutical companies in the preceding year.

Another linked payments from opioid manufacturers to an increased likelihood of doctors prescribing dangerously high doses.

The findings raise concerns about the potential consequences of pharmaceutical marketing, particularly in cases involving medicines associated with serious health risks.

Dr. Quinn Grundy, a co-author and associate professor at the University of Toronto, said doctors who accepted free meals, consulting fees, advisory board payments and visits from sales representatives tended to prescribe more promoted medicines, often at higher costs.

The review also examined policies introduced by hospitals and medical schools to limit pharmaceutical marketing, including restrictions on gifts, free samples and meetings with sales representatives.

Researchers found that doctors working under stricter policies tended to make more appropriate prescribing decisions. The impact on prescription volumes varied, while evidence concerning overall cost reductions remained unclear.

In one study, psychiatrists operating under tighter restrictions on pharmaceutical sales visits were less likely to prescribe antipsychotics and antidepressants to children, including for conditions or uses not officially approved.

However, researchers cautioned that many studies examined prescribing patterns at a single point in time, making it difficult to establish whether pharmaceutical interactions directly caused the observed differences.

The review also found insufficient evidence to draw firm conclusions about the effects of free drug samples and pharmaceutical promotions on hospital decisions to approve medicines for use.

The findings come amid concerns about growing pharmaceutical promotional activities. A separate follow-up study cited by the researchers found that the proportion of doctors reporting receipt of free drug samples increased from 11.4 per cent in 2011 to 21.6 per cent in 2024. Discussions with pharmaceutical representatives rose from 30.4 per cent to 45.6 per cent over the same period.

The researchers called for stronger conflict-of-interest policies, including restrictions on gifts, payments and sales visits, as well as measures to limit doctors’ exposure to industry promotion during medical training and throughout their careers.

Bero said patients should receive treatments based on clinical evidence rather than pharmaceutical marketing.