January 25th, 2019
When it comes to marketing by pharmaceutical companies to doctors, just a little goes a long way. A recent study in JAMA by Boston Medical Center pediatrician and addiction specialist Dr. Scott Hadland and colleagues measured patterns in opioid marketing to doctors across more than 2000 counties. They found that increases in opioid marketing to doctors were associated with increases in opioid prescriptions and opioid-related overdose deaths in those counties.
Much of the media surrounding opioid marketing has focused on payments for doctors that were exceptionally high prescribers. However, this study found that the number of marketing interactions with physicians was more strongly associated with mortality from opioid overdoses than the dollar value of marketing.
These findings suggest that “matters is not so much the high value of payments to a few doctors, but the low value of payments to many doctors, for such things as meals,” said Dr. Magdalena Cerda, associate professor at the NYU School of Medicine and one of the study authors, quoted in STAT.
It may sound surprising, but previous studies also show that benefits as small as a meal can influence doctors’ prescribing habits. A 2016 study of nearly 280,000 physicians showed that doctors who had received just one meal from a pharma company (with a value of $20 or less) had significantly higher rates of prescribing that company’s medication compared to the generic version. And ProPublica‘s analysis of OpenPayments data found that doctors who received just a meal from drug and device makers prescribed a higher percentage of brand-name drugs compared to doctors who didn’t.
It’s no wonder that pharmaceutical companies spend more than $20 billion on marketing to health care professionals each year. They spend it because it works. As Dartmouth professor Dr. Steve Woloshin said in a WBUR interview, “FDA can monitor the print and television ads, but they have no way to monitor what goes on in detailing encounters, or the drug company dinners, or the training programs to push their agenda. And that’s a recipe for disaster.” The more we study the opioid crisis, the more evidence we find that this disaster was fueled in no small part by pharma marketing.