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Prescriptions of physicians influenced by laboratories

French generalists who receive laboratory gifts tend to be less effective. This is shown in a study published this November 6th in the BMJ.

Conversely, those “who receive no benefit from the pharmaceutical industry are associated on average with better indicators established by the Health Insurance as to the effectiveness of their prescriptions”.

“These costs globally cheaper,” conclude its authors, doctors, researchers and engineers at the university and the University Hospital of Rennes.

Influence on prescriptions

These results do not show a causal link but “reinforce the hypothesis that the pharmaceutical industry can influence the prescriptions of GPs.

They offer an insight into the extent of this influence, “said the university, the University Hospital and the School of Advanced Studies in Public Health in a statement.

“This influence, sometimes unconscious among doctors, can lead to choosing a treatment that is not optimal, to the detriment of the health of the patient and the cost to the community,” they add.

Transparency and links of interest

The study, published in the British Medical Journal (BMJ), is based on the cross-fertilization of two databases: the first is the Transparency Santé portal, on which all the “links of interest” of health professionals must be declared.

This concerns in particular the equipment, meals, transport or hotel costs offered by companies in the sector (pharmaceutical laboratories, manufacturers of medical devices, etc.), starting at an amount of 10 euros.

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The second base is the National Health Data System (NSDS), a merger that was created in 2017 from two pre-existing databases and which lists consultations, medical procedures, medication prescriptions and hospitalizations reimbursed while maintaining the anonymity of the insured.

90% of GPs received a gift

According to this database, “nearly 90% of general practitioners have already received at least one gift since 2013,” said Pierre Frouard, general practitioner in Rennes and coordinator of the study.

“This is the first study of this magnitude in France” that exploits the data of this portal, says Bruno Goupil, first author of the study, interviewed by AFP.

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The authors screened the prescriptions of a little more than 41,000 general practitioners working exclusively in the liberal and classified them into six groups, according to the amount of benefits received during the year 2016.

Other doctors make less expensive prescriptions

They have shown that “on average”, “the group of doctors who received no benefit (…) is associated with less expensive prescriptions, more prescriptions of generic drugs compared to the same non-generic drugs” (for three types of drugs).

They make “fewer prescriptions of vasodilators and benzodiazepine for long periods”, the use of which is not recommended by the Health Insurance, “fewer prescriptions of sartans” compared to another family of drugs, recommended for their similar effectiveness with a lower cost.

Fewer generic prescriptions

In contrast, “there is no significant difference for the prescription of aspirin, generic antidepressants or generics of proton pump inhibitors”, anti-acidity drugs.

The authors also show that the higher the total amount of benefits received, the higher the average incremental cost per prescription, as well as the prescription deficit of generic versions for antibiotics, antihypertensives and statins.

23% of the turnover of laboratories is used for the promotion of medicines

“Pharmaceutical companies spend a lot of money on drug promotion (23% of their turnover is more than for research) whose gifts are only a part,” says Dr. Goupil, citing a report from the European Commission published in 2009.

“It seems unlikely that this money will be spent at a loss and the results of our study are consistent with existing studies in favor of an influence on prescriptions,” he adds.

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