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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Bingo Tedhe Medhe, Fun Stix, Kurkure, Char-Chare, and Taka-Tak fail fat test!
Extruded snacks may sound like food jargon for everyday items namely Kurkure, Fun Stix and so on but it’s just a way of segregating a category of snacks made by a different process in this case extrusion cooking,  says Consumer Voice in a report. 
Five brands have been tested by Consumer Voice magazine and a major factor of safety for these ready to eat extruded snacks was total bacterial count. As brought to light by Consumer Voice not all brands fulfil this safety report.
According to Consumer Voice, a voluntary organisation working towards consumer education, ready to eat extruded snacks prepared by extrusion cooking involve the preconditioned raw food material to be subjected to high temperature short time cooking, which results in a plastic consistency in the material, following which the material is extruded through specifically tapered dies. As it emerges from the dies, it passes from a high pressure to a low pressure zone, which results in puffing of the final product. Finally, the product is coated with oil, flavours, salt spices, sweetening agent and packed. 
The brands tested by consumer voice included Bingo Tedhe Medhe, Fun Stix, Kurkure, Char-Chare, and Taka-Tak.
The report published by Consumer Voice mentioned the various testing parameters for the products.
  1. Total Bacteria Count: this is the amount of viable bacteria in a food product and serves as a key indicator of the products overall quality and safety. As per IS total bacteria count should not be more than 50,000 colony-forming unit (cfu) per gram.
    a. Fun Stix had the maximum bacterial count at 10,901 cfu per gram, which is above the prescribed limit in the Indian standards and hence not suitable for consumption.
    b. Kurkure had the least with 1,273 cfu per gram as reported by Consumer Voice.
  2. Fat on dry Basis (percentage): The visible fat intake in diets can go up to 50gm/person/day on the level of physical activity and physiological status. Adults with a sedentary lifestyle should consume about 25 grams of visible fat while those involved in hard physical work require 30-40 gm. Fat content in ready to eat extruded snacks should not be more than 25%.

  3. Packaging: The product shall be placed in flexible thermoplastic films or multi-layer or mono-layer construction or other laminates with paper and/or aluminium foil so as to provide high resistance to the passage of oxygen and water vapour and also to produce effective heat seal. The sealing shall be done hermetically with or without nitrogen flushing to retain the contents in a fresh condition. All brands were packed in thermoplastic films with nitrogen flushing.
    Consumer Voice also explored the peroxide value of extracted fat present in extruded snacks. Detection of this value is evidence of rancidity in fat or oils. As per IS 12566:1989 in ready to eat extruded snacks the value of extracted fat should not be more than 10 mq oxygen per kg fat. In the tests conducted by Consumer Voice peroxide value of extracted fat was nil for all brands, deeming them fit for consumption.
  4.  Marking: The following information shall be clearly and indelibly marked on the label of each container/packet as per food safety and standards (packaging and labelling) Regulations and Legal Metrology(Packaged commodities) Rules:
a) Name of the product
b) Trade name, if any
c) Name and address of manufacturer 
d) Batch or code number
e) Net quantity in gram or kg
f) Month and year of manufacture
g) The words 'Best Before' (month and year to be indicated)
h) Nutritional information
i) FSSAI license number
j) Logo indicating vegetarian and non-vegetarian status
k) Storage information
l) Maximum Retail Price (MRP)
m) Customer-care details 
Consumer Voice is a voluntary action group, consisting of academicians, professionals and volunteers channelising their energies towards creating informed consumers. You can subscriber to their magazine here.
-source Consumer Voice magazine issued  June 2016



Ramesh Poapt

1 year ago

error seems in bacteria count of the 2 products referred above- 50000 , 10901,1273? but still, a very good article.........!!!

Vegetable prices soaring again on ‘scarcity’
As if the delayed monsoon was not making lives much easier, consumers are being made to shell out more money for buying everyday vegetables. Especially, prices of tomatoes have zoomed to about Rs100 per kg within a fortnight across the country. While some experts feel that this is due to lower crop output, few consumers are blaming this on hoarders and the government for its failure to arrest this sudden price rise. 
In Mumbai, while the tomatoes are being sold at Rs100 per kg as against Rs50 two weeks ago, in Delhi the prices have gone up to Rs35 from Rs17.50 per kg. Prices of cluster beans, cauliflower, brinjal, bottle gourd, green chilli, capsicum and other vegetables have also gone up while green vegetables such as spinach, methi and coriander have been witnessing a 100% hike in prices over past few weeks.
According to Twitterati, this sudden rise in prices is due to not allowing vegetables enter the market. One Ajay Singh says, “Trucks are stopped on roads, only limited supply letting into the market. At the same time, procurement of tomatoes from farmers hit low of Rs3-4 per kg.”
Some feels that the agricultural produce market committee (APMC) are playing games with supply and demand. At present, farmers in Maharashtra have to sell their vegetables and fruits to licensed traders of APMCs, who then sell it to vendors and retailers. The state government proposed to allow farmers directly sell their produce to consumers, which apparently have not gone down well with the APMC traders and members of the unions.
The National Horticulture Board (NHB) has provided a flat growth forecast for crop year 2015-16 on vegetable production. NHB says vegetable production during 2015-16 would decline marginally to 168.5 million tonnes (mt) from 169.48 mt a year ago. High temperatures during April and May have affected tomato production adversely in the key growing belts of Maharashtra like Narayangaon and Junnar near Pune as well as northern parts of the country, say experts. 
Speaking with Business Standard, Shriram Gadhave, president of Vegetables Growers Association of India, said, “Yield has been severely lower this year, with farmers witnessing 25% recovery of major vegetables, after summer heat. As against eight tonnes per acre of tomato output in the normal case, farmers are harvesting two 2 tonnes or less. The quality of harvest is also poorer than expected.” 
According to Gadhave, the high temperatures during April and May resulted in around 85-90% of flowers and leaves of vegetable plants being dropped, leaving hardly 10% of the farmers with a crop, especially tomatoes. 
There has also been a sharp decline in arrivals due to crop losses. Add to this the severe drought in Maharashtra, which has affected overall production of vegetables. At Vashi, average arrival is down to 100 to 150 trucks from an average of over 500 trucks. This wholesale market receives about 500 to 550 trucks of vegetable and other agricultural produce every day. Due to the drought, most traders from Maharashtra are procuring vegetables from other states, like Gujarat, Uttar Pradesh, Punjab, Karnataka and Haryana. However, this is also not sufficient and has led to price increase, feels the traders.
According to experts, this situation is likely to remain for the next two months or till new crops comes in. “Vegetables sown now with the onset of the monsoon rain would be harvested only by the end of August. Till then, consumers will have bear with high prices,” Gadhave told Business Standard
Here are the wholesale prices as on 14 June 2016 at Mumbai market...



Suresh Gopal

1 year ago

I suppose there is a lot of market manipulation in all this

Amit Anam

1 year ago

Like dal price , here also the govt is caught sleeping while the prices were increasing and the media went gaga over chest thumping victory of our PM over USA, totally ignoring the price rise issue which is hurting over 90% of our population

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