I’m sure most of us don’t think that the little trinkets (pens and notepads and such) or a few slices of pizza that we might receive from a drug company affects what we prescribe for our patients.

We would be wrong. Drug companies buy lunches for doctors because they know they have an impact. New rules have reduced the number of expensive free vacations and similar high priced gifts that were, sadly, never offered to me, but lunches and other small gifts are still allowed in some jurisdictions. The authors of this study (DeJong C, et al. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA internal medicine. 2016;176(8):1114-10) were able to get data from a registry of gifts to doctors and medicaid prescribing patterns. They focused on 4 drugs that I never prescribe and I don’t know anything about, which were the most prescribed drugs in their class of medication.

Most of the gifts were meals under $20, doctors who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins , nebivolol over other β-blockers, olmesartan over other ACE inhibitors and ARBs  and desvenlafaxine over other SSRIs and SNRIs. Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.

I am sure that most of this is unconscious, its hard to think of a shared pizza as an effective bribe, but getting a lunch free a few times in a year makes you feel more kindly disposed to the makers of rosuvastatin than the makers of the other statin whose name you can’t remember and whose rep never bothered to even get you a coffee.

You can see this graphically here:

Someone told the authors to finish the abstract with the following sentence, “The findings represent an association, not a cause-and-effect relationship” which is of course an incorrect statement. An association is not necessarily a cause and effect relationship. But it may be. Sometimes an association is found because there really is a cause and effect relationship.

Doctors can afford to buy their own lunches. Our prescribing practices should not be influenced by anything other than the good of our patients.