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Study: Doctors Give In To Patient Demands For Brand-Name Drugs

By Alvin Tran

January 7th, 2013, 5:41 PM

Doctors are more likely to prescribe brand-name drugs over lower-cost generics when patients request them and when physicians have contacts with drugmakers, a study published in JAMA Internal Medicine Monday shows.

Photo by Paul Pellerito via Flickr

The researchers from Massachusetts General Hospital in Boston analyzed data from a survey of 1,891 doctors in 2009 and found that 37 percent of  doctors admitted to sometimes prescribing a brand-name drug at a patient’s request even though a generic version of the medication was available. They also found that doctors who had received free food and beverages from a drugmaker were more likely to give in to such patient demands.

Dr. Eric Campbell, the study’s lead author and a professor of medicine at Harvard Medical School, said it is important to note the results show that a majority of physicians – more than 60 percent – are not succumbing to such pressures. “Why this is important is because brand-name drugs are between probably 30 and 80 percent more expensive than the generics,” he added.

According to Campbell, many physicians often disregard the idea that common marketing practices of pharmaceutical companies influence the way they prescribe medications. But he suggests that it does have an impact. “There’s absolutely no doubt that these things influence physicians’ behavior to use the companies’ products. Denying that this exists is like denying that gravity exists,” he added.

Campbell and his colleagues also found that compared to those with less experience, physicians who have been in the workforce longer were more likely to engage in this behavior, although it is not clear why. “It might be that physicians who have been in practice longer may not have been trained around issues of conserving scarce medical resources in the same way that younger physicians have,” Campbell said, also adding that the relationship between drug companies and physicians might not have been seen as problematic when these doctors were trained as it is today.

Internists and psychiatrists were the most likely to prescribe the brand-name drugs. Several other specialties, including pediatrics, anesthesiologists, cardiologists, and general surgery, were significantly lower. Although his research did not address the variation among the medical specialties, Campbell believes the difference may be due to the diseases each specialty sees and the availability of new drugs used to treat them. “I think it has to do something with the nature of the drugs. For example, there aren’t as many new brand-name drugs in pediatrics compared to internal medicine,” Campbell added.

The federal government is working on rules to make clear when drugmakers provide gifts and entertainment to doctors. The Physician Payment Sunshine Act requires that the companies make available to the public a list of payments to doctors, including those for speeches, research and travel expenses. The regulations are still being finalized by administration officials.

“There’s pretty strong evidence linking educational efforts of pharmaceutical companies and gifts to prescribers to increased prescribing of more expensive brand-name drugs,” said Dr. Brian Alldredge, a professor of clinical pharmacy and neurology at the University of California, San Francisco. But in addition to focusing on medication prescribers, Alldredge adds that it is also important to look at patients, as they are also targets of widespread direct-to-consumer advertising campaigns for prescription medications. “I think it remains as an enormous problem,” Alldredge added.

“Given that brand-name drugs, in general, are much more expensive than their generic counterparts, this has the potential to be an extreme and unnecessary use of resources,” Campbell said.  Since the brand-name drugs provide no additional benefit to patients, “the only group that wins are the drug companies.”

3 Responses to “Study: Doctors Give In To Patient Demands For Brand-Name Drugs”

  1. Renee says:

    I think the title of this entry is misleading – they don’t “give in” to demands, but merely prescribe often without having any type of conversation with a patient. They will always go immediately to a newer drug when prescribing anything – either because their drug rep was in that very morning with snacks for the office, or because they simply don’t take the time to examine other drugs in the same category that may be effective & less costly for the patient. I train all of my insurance clients to use their formulary when talking with a doctor. I deal with a lot of Medicare patients & the cost of drugs is literally killing them. I always advise that at the beginning of a new year, or if a significant change in health takes place requiring new prescriptions that they have a “pharmaceutical consult” with their primary physician to review the drugs being taken & whether or not their formulary lists less costly alternatives that may be effective. Oh, and I also find that very few of my client’s physicians talk to them about healing through nutrition and other means . . . . Big pharma has a real hold on the doctors, if you ask me.

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  3. Dr. Campbell is off base when he makes a blanket statement that brand name drugs provide no additional benefit to patients and only benefit the drug companies. In my case, I have glaucoma and take Timoptic XE .5mg daily. On two separate occasions, my pharmacy was not able to obtain the brand drug so I settled for a generic made by Falcon. In both cases, the pressure in both eyes jumped 5 points within a month or two of using the generic product. As soon as I went back to the brand product (made by Aton), my pressure fell 5 points down to 15, the number desired by my opthalmologist. I have read that this often happens because the suspension in which generic companies place the active drug differs from that of the brand name products and, hence, absorption of the drug is compromised. I have spoken with 2 eye doctors and both confirmed that generic Timolol isn’t effective for many patients like me. As a result of using generics, I have to see my doctor 4 times a year rather than twice a year so that he can monitor my pressure more closely. My generic experiment has resulted in my insurance company spending extra money for my health care.