Two new studies suggest that doctors overprescribe painkillers and that they may be swayed to prescribe any drug too often if presented with kickbacks, such as money and gifts, from drug companies and sales reps.
In a study published last week by the Social Science Research Network, researchers from the Rady School of Management at University of California, San Diego found that more than half of the 330,000 physicians in their study received payment of some kind for prescribing specific drugs.
“When a doctor is paid, we find he is more likely to prescribe a drug of the paying firm, both relative to close substitutes and even generic versions of the same drug,” they determined. “This payment-for-prescription effect scales with transfer size, although doctors receiving only small and/or infrequent payments are also affected. Although the pattern holds in nearly every U.S. state, it is strongly and positively related to regional measures of corruption.”
The report came ahead of the Physician Payments Sunshine Act, which takes effect next year, requiring drug and medical device manufacturers to publicly report payments to physicians and teaching hospitals.
In 2009, payments from pharmaceutical companies to doctors was at about $188.86 million. By 2011, that number had jumped to $773.05 million, but much of that increase was attributed to companies being more willing to admit how much they had paid out. Most payments came in the form of meals, ranging around $37 per meal.
The average doctor in the study generated about 2,980 prescriptions from 217 patients. However, doctors who got payments from pharmaceutical companies gave out 3,566 prescriptions fomr 243 patients. These same doctors were more likely to prescribe a brand name drug than a generic version.
Kickback Schemes Lead to Government Fraud Lawsuits
In recent years, number of companies have been hit by lawsuits from the Department of Justice over such claims.
One of the largest resulted in a Pfizer settlement for $2.3 billion in 2009, after the drug maker was accused of illegal marketing and kickbacks associated with the painkiller Bextra and other drugs. Prosecutors said Pfizer gave doctors kickbacks and incentives that included paying them for weekend meetings in resort locations.
Just this year, C.R. Bard agreed to pay $48.26 million to settle a whistleblower lawsuit which claimed it paid illegal kickbacks to doctors who used its radioactive seeds to treat prostate cancer. The company gave them free medical supplies, grants, rebates, conferencing fees and marketing assistance.
Such kickback schemes are considered a form of Medicare fraud.
Doctors Overprescribing Painkillers
In the second of the recent studies, Harvard researchers found one possible side effect of all those kickbacks. They determined that overall doctors are prescribing too many powerful painkillers and requesting too many expensive tests for back pain due to confusing treatment guidelines.
The study was published late last month in the medical journal JAMA Internal Medicine, finding that doctors have reduced the number of prescriptions of acetaminophen and other nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain and increased the number of narcotic prescriptions. They are also prescribing more computed tomograms and magnetic resonance images (MRIs), though researchers could find nothing to account for the changes.
Researchers looked at nationally representative data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to assess back pain treatment from January 1, 1999, through December 26, 2010.
They found that the rate of prescription of acetaminophen (the primary ingredient in Tylenol) and NSAIDs such as Motrin and Alleve for back pain had decreased from 36.9% in 1999-2000 to 24.5% in 2009-2010. At the same time, the rate of prescription of narcotics for back pain, like OxyContin and Vicodin, increased from 19.3% to 29.1%. The rate of expensive scans such as MRIs for back-related pain also increased from 7.2% to 11.3% over the course of the study.
Researchers in the Harvard study blamed the changes on “discordant” guidelines for back pain management and treatment.
“Improvements in the management of spine-related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care,” the researchers determined.