Consumer Issues
Feed Me, Pharma: More Evidence That Industry Meals Are Linked to Costlier Prescribing

Evidence is mounting that doctors who receive as little as one meal from a drug company tend to prescribe more expensive, brand-name medications for common ailments than those who don't.


A study published online Monday in JAMA Internal Medicine found significant evidence that doctors who received meals tied to specific drugs prescribed a higher proportion of those products than their peers. And the more meals they received, the greater share of those drugs they tended to prescribe relative to other medications in the same category.


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The researchers did not determine if there was a cause-and-effect relationship between payments and prescribing, a far more difficult proposition, but their study adds to a growing pile of research documenting a link between the two.


A ProPublica story published in March found that doctors who took payments from the pharmaceutical and medical device industries prescribed a higher proportion of brand-name medications than those who didn't. It also found that the more money a doctor received, the higher the percentage of brand-name drugs he or she prescribed, on average.


Similarly, a Harvard Medical School study published in May found that Massachusetts physicians prescribed a larger proportion of brand-name statins 2014 the category of drugs that treat high cholesterol 2014 the more industry money they received. There was no significant increase in brand-name prescribing for those who received less than $2,000.


What makes the current study different is that it looked at specific drugs.


In an editor's note, Dr. Robert Steinbrook wrote that the recent analyses "raise a broader question. Is it necessary to prove a causal relationship between industry payments to physicians and the prescribing of brand-name medications?"


Other than for research and development, and related consulting, Steinbrook wrote, "it is already evident that there are few reasons for physicians to have financial associations with industry. Outright gifts, such as meals, may be legal, but why should physicians either expect or accept them?"


Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry trade group, said the latest study creates more confusion than clarity. In part, that's because the researchers acknowledge that they could not determine whether the drugs were prescribed before or after doctors received meals paid for by companies.


"This study cherry-picks physician prescribing data for a subset of medicines to advance a false narrative," Campbell wrote in an email. "Manufacturers routinely engage with physicians to share drug safety and efficacy information, new indications for approved medicines and potential side effects of medicines. As the study says, the exchange of this critical information could impact physicians' prescribing decisions in an effort to improve patient care."


Since 2013, the government has required all pharmaceutical and medical device makers to publicly report their payments to doctors. The government has released data on transactions from August 2013 to December 2014; data from 2015 is set to be made public next week. Those payments can be searched in ProPublica's Dollars for Docs tool.


In the study released today, a team led by Colette DeJong at the University of California San Francisco examined four classes of medications, including those that treat high cholesterol, heart rhythm disorders, high blood pressure and depression. The researchers identified one heavily marketed brand-name drug in each class 2013 Crestor, Bystolic, Benicar and Pristiq 2013 for which there are cheaper, equally effective options.


DeJong and her colleagues then looked at physicians who received meals specifically tied to those drugs (companies have to list the products associated with each of their payments) and their 2013 prescriptions in Medicare's drug program. The researchers excluded physicians who received other types of payments2014such as for promotional speaking and consulting2013in an effort to isolate any relationship to the meals alone.


Though only a relatively small percent of physicians who prescribed the drugs examined in the study received payments from their makers, those doctors prescribed the drugs more often than other doctors.


Physicians who received meals related to Crestor on four or more days prescribed the drug at almost twice the rate of doctors who received no meals. The difference was even more marked for the other drugs. Physicians who received meals prescribed Bystolic at more than 5 times the rate of their uncompensated peers, Benicar at a rate 4.5 times higher, and Pristiq at a rate 3.4 times higher.


Higher rates of prescribing were also observed when doctors received just a single meal, even after taking into account a physician's specialty and region of practice.


Dr. R. Adams Dudley, a professor of medicine and health policy at UCSF and one of the study's authors, said he and his colleagues expected to see "some evidence that doctors were responsive to incentives, what with their being humans and all."


Still, he said, "I think we were probably surprised that it took so little of a signal and such a low value meal2026It has changed our thinking."


DeJong said the researchers don't think the meals themselves cause doctors to prescribe more of a drug, but rather the time they spend interacting with drug reps when they drop off those meals.


"There's really no way that a $10 bagel sandwich can influence a doctor in a gift way," she said. "We think it represents more reciprocity, the time spent with the drug rep and the fact that the doctor is listening to this 10-minute pitch."


Dudley suggested that patients talk to their doctors and ask "Is there a generic that's just as good?"


"Hopefully they can get the doctor off of the prescribing behaviors that we're observing."


Deputy data editor Olga Pierce contributed to this report.


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What Brexit could mean for India
Markets bracing for the Monday of the week of "Brexit", when Britain possibly exits from the European Union, will now, following the BSE Sensex fall of 400 points last week provoked by this possibility, now have to contend with the shock news of RBI Governor Raghuram Rajan's Saturday decision to step down when his term ends in September.
Rajan's bombshell, coming just ahead of the Brexit vote on June 23, could trigger volatility in the stock bond and currency markets.
In the letter to his colleagues on Saturday announcing that he was not seeking a second term and will return to academia when his tenure ends in September, Rajan made reference to the upcoming referendum in Britain.
"Colleagues, we have worked with the government over the last three years to create a platform of macroeconomic and institutional stability. I am sure the work we have done will enable us to ride out imminent sources of market volatility like the threat of Brexit," he said.
But the biggest risk to the key equity indices stems from Britain's possible exit from the EU. There might be far-reaching effects on global stock markets, as well as the international currencies, if Brexit materialises.
Besides, domestic investors will be concerned about the direct negative impact that some of the India-based companies and sectors that have investments and exposure to Britain will suffer.
The possible British exit will also lead to greater investments into less risky assets like gold and increase the overall outflows from the domestic equity markets.
"It is expected that the market would remain a little volatile due to the global events. Brexit is expected to heighten global volatility, thereby impacting capital flows at home," D.K. Aggarwal, Chairman and Managing Director, SMC Investments and Advisors, told IANS.
Minister of State for Finance Jayant Sinha has said the government is assessing the possible fallouts of Brexit.
Both Brexit and Rajan's decision not to seek a second term might flare up volatility in the Indian equity markets in the upcoming week.
Investors will also be concerned over an initial deficit in monsoon rains, fluctuations in rupee value and food prices.
According to market observers, come Monday, June 20, a dour mood is expected to engulf investors.
"The RBI Governor's exit news could prompt investors to recheck their bullish convictions," Anand James, Chief Market Strategist at Geojit BNP Paribas Financial Services, told IANS.
But the biggest risk to the key equity indices stems from the possible exit of Britain from the EU, with the decision subject to a referendum which will be conducted on June 23.
"India invests more in the UK than in the rest of Europe combined, emerging as the UK's third largest FDI investor. Access to European markets is therefore a key driver for Indian companies coming to the UK," said Chandrajit Banerjee, director general of Confederation of Indian Industry (CII).
"Anything that lessens this attractiveness may have a bearing on future investment decisions. It is important also to ensure continued border-free access to the rest of Europe for the many hundreds of existing Indian firms that have base in the UK," he added.
Britain ranks 12th in terms of India's bilateral trade with individual countries. It is also among just seven in 25 top countries with which India enjoys a trade surplus.
As per data with the Commerce and Industry Ministry, India's bilateral trade with Britain was worth $14.02 billion in 2015-16, out of which $8.83 billion was in exports and $5.19 was in imports. The trade balance thus was a positive $3,64 billion.
This apart, the country brief of India's Ministry of External Affairs says Britain is also the third largest investor in India after Mauritius and Singapore, with a cumulative inward flow of $22.56 billion between April 2000 and September 2015.
Likewise, India is also the third largest investor in Britain. Last year alone the value was estimated at 1.9 billion pounds (around $2.75 billion). "UK attracts more Indian investments than the rest of the EU altogether," says the brief.
A. Didar Singh, secretary general, of industry chamber Ficci has said: "We firmly believe that leaving the EU would create considerable uncertainty for Indian businesses engaged with UK and would possibly have an adverse impact on investment and movement of professionals to the UK."
Also, if Britain does leave the EU, it could lead to volatility in the pound, which would increase the risks for Indian businesses.
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.


Regulations on a new tax regime, foreign portfolio investors and new bankruptcy code will transform India’s finance market
Global credit rating agency Moody's Investors Service on Monday said the three recent regulatory changes made by India will have transformative implications for its structured finance market.
"The changes will improve returns to investors, promote foreign investment, and improve the resolution process in the event of default, thereby strengthening creditor rights," Vincent Tordo, an analyst with Moody's, was quoted as saying in a statement.
"Specifically, the measureas are a new tax regime that will lift post-tax investment returns from securitisation trusts; changes in regard to foreign portfolio investors (FPIs) that will encourage foreign investment and changes to deal structures; and a new bankruptcy code that will reinforce creditors' rights," Tordo said.
Moody's conclusions were contained in a just-released report on India's securitisation market, "New Regulations Pave Way for Market's Transformation; Improved Creditor Rights".
"Together, these three changes will help -- as indicated -- further develop India's structured finance market, and allow securitisation to play a bigger role as a source of funding in the economy, an objective promoted by the government," said Tordo.
According to Moody's, the new tax rule will increase post-tax returns from investments in pass through certificates (PTCs). The issue volume of PTCs have fallen due to lower demand from bank investors put off by current lower returns.
The participation of foreign investors through the new FPI rules will help the Indian market evolve so that it becomes more in line with global practices; for example, encouraging it to evolve away from structures with single tranches and single investors into those with multiple tranches and multiple investors.
The bankruptcy code, once implemented, will over time strengthen the legal framework of India's credit markets by significantly increasing the bargaining power of creditors against debtors in the resolution of distressed assets, Moody's said.
The code will also provide greater clarity on the insolvency process, a key aspect of the risk analysis of securitisation transactions, Moody's said.
Disclaimer: Information, facts or opinions expressed in this news article are presented as sourced from IANS and do not reflect views of Moneylife and hence Moneylife is not responsible or liable for the same. As a source and news provider, IANS is responsible for accuracy, completeness, suitability and validity of any information in this article.



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