Many Doctors Prescribe Costlier Drugs Than Needed, Study Finds
Many Doctors Prescribe Costlier Drugs Than Needed, Study Finds [Milwaukee Journal Sentinel]
From Milwaukee Journal Sentinel (WI) (January 8, 2013)
Jan. 08--More than a third of doctors said they prescribe brand name drugs simply because patients ask for them even when cheaper generics would be appropriate, according to a new study.
The practice, which can contribute to higher health care costs, was found to be more likely among doctors who received free drug samples or free food from drug companies or who had financial relationships with drug companies.
"It is a classic measure of waste in medicine," said lead author Eric Campbell, an associate professor of medicine at Harvard Medical School.
The paper, published online Monday in JAMA Internal Medicine, involved a national survey of about 1,900 doctors from a variety of specialties.
A total of 37% of doctors said they sometimes or often prescribed brand name drugs if patients asked even if an equivalent generic was available.
If drug companies provided food or beverages at the workplace, 39% of doctors prescribed brand name drugs when patients asked, compared with 33% of doctors who did not get free food. If drug companies provided free drug samples, 40% of doctors prescribed brand name drugs, compared with 31% among those who did not get free samples.
Also, 40% of doctors who said they stayed up to date by meeting with drug company representatives prescribed brand name drugs vs. generics, compared with 34% of doctors who rarely or never met with drug reps.
The findings confirm what many people suspected, said Eric Cohen, a kidney specialist at the Medical College of Wisconsin and Froedtert Hospital.
"It makes perfect sense," said Cohen, who was not a part of the study. "Even the smallest gift will sway someone’s opinion. They (drug companies) don’t do it out of the goodness of their heart."
As a kidney specialist, Cohen said he often sees patients with pain who want the brand name painkiller Percocet instead of the generic equivalent.
Both drugs combine the opioid oxycodone with acetaminophen. But 30 tablets of the generic cost $52, compared with $217 for the brand name, he said.
In 1988 Cohen wrote a paper warning that if consumer advertising of drugs was allowed, it would become another intrusion on the doctor-patient relationship.
Cohen and other doctors contacted for this story said consumer drug advertising, which began in the U.S. in 1997, is the main reason why doctors give in to patient demands and prescribe brand name drugs.
Only the U.S. and New Zealand allow such advertising, said Richard Deyo, a professor of evidence-based family medicine at Oregon Health and Science University.
Deyo said it is easier and faster for doctors to acquiesce to patients’ demands for an advertised drug than to spend time explaining the disadvantages of doing so. That’s especially true among doctors who don’t want to alienate their patients, he said.
"I understand the free speech argument for TV advertising, but wish we could find a solution for limiting prescription drug advertising, like nearly every other country," said Deyo, who was not a part of the study.
Many factors, group says
In a statement, the industry group that represents drug companies said many factors, not just patient demands, determine what drugs doctors prescribe. Those include clinical treatment guidelines, drug formularies, medical journal articles and doctors continuing medical education, said Matthew Bennett, a spokesman with the Pharmaceutical Research and Manufacturers of America.
Because patients can respond differently to medications, it is important for doctors and patients to be able to choose from multiple therapies, he said.
"Ultimately, physicians make treatment decisions on a case-by-case basis, in the best interest of each patient," he said.
He said 80% of prescriptions filled in the U.S. already are generics.
Journal Sentinel stories that were part of the Side Effects series have found that financial conflicts also have existed in some of the factors cited by Bennett, including medical journal articles, clinical treatment guidelines and continuing medical education.
Last month, the newspaper reported that national treatment guidelines associated with the 25 top-selling brand name drugs in America -- medications that cost more than $90 billion in 2011 -- were heavily influenced by doctors who had worked as paid speakers, consultants and advisers to drug companies.
The findings in the new JAMA paper are very disappointing, said Arthur Caplan, a professor of medical ethics at NYU Langone Medical Center.
The paper suggests that a variety of factors are at work, including consumers being bombarded with TV ads, doctors who have little time and a lack of interest in reigning in costs.
"We may have to toughen the practice laws to say that everybody has to start with a generic first," Caplan said.
Internal, psych highest
For the study, 2,900 doctors in a variety of specialties were surveyed, including internal medicine, family practice, pediatrics, anesthesiology, psychiatry, general surgery and cardiology. About 1,900 doctors responded.
The highest rates of doctors agreeing to prescribe brand name drugs over generics were in internal medicine and psychiatry, where 50% of doctors said they did so.
Study author Campbell noted that both fields represented large markets for new drugs used to treat long-term chronic conditions. And those more expensive medications might not be any better than generics, he said.
He said generics are between 30% and 80% cheaper than brand name drugs.
Campbell noted that it is likely that a higher number of doctors prescribed brand names instead of generics than was found in his survey. That’s because practices that might be viewed negatively tend to be underreported in such surveys, he said.
The good news, he said, is that 63% of the doctors in the survey said they rarely or never prescribed brand name drugs over generics just because patients requested the drugs.
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Posted: January 2013
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