Cochrane review: drug-company gifts and payments linked to worse, costlier prescribing

A systematic review published on 9 October in the Cochrane Database of Systematic Reviews examined how interactions between pharmaceutical companies and doctors — sales-rep visits, gifts, meals, payments, free samples and sponsored education — relate to prescribing.

Key findings

• Gifts or payments: doctors who received them tended to prescribe less appropriately and write more prescriptions; costs probably rose. The authors describe this as “high-certainty evidence” of a harmful effect.
• Detailing and industry-sponsored education were also linked to less appropriate, costlier prescribing and probably more prescriptions.
• Conflict-of-interest policies that restrict or manage contacts with industry likely improved prescribing choices and may have reduced the number of prescriptions; their effect on costs was unclear.

The findings covered different drug types, promotional activities, and both primary-care physicians and specialists.

Limitations

Most included studies measured prescribing at a single point in time, which makes it hard to show that industry contact caused the differences: doctors who prescribe more may also attract more marketing. The evidence is largely observational, and certainty varied across outcomes.