Doctors who accepted at least four free meals in a year from the maker of a $480 asthma inhaler went on to prescribe it about twice as often as doctors who got none, according to a Bedside analysis of federal payment and prescription data.
The meals were not expensive. The median value was $19, roughly a sandwich, chips and a drink brought to a clinic at lunchtime. But the pattern held across specialties, states and practice sizes, and it held after we accounted for how many asthma patients each doctor treated.
The analysis does not show that the meals caused the prescriptions. Doctors who already like a drug may be more willing to sit through a lunch about it. But the size of the gap, and how steadily it grew with the number of meals, matches a body of earlier research on other drugs.
What we found
We looked at about 61,000 primary care doctors, lung specialists and allergists who wrote at least 20 prescriptions for asthma inhalers in Medicare’s drug program last year. We matched them to a federal database where drug companies must report payments to doctors, including meals.
How we did this analysis
- Doctors: about 61,000 who wrote 20 or more asthma inhaler prescriptions in Medicare’s drug program
- Payments: federal records of meals from the inhaler’s maker, Pellridge Respiratory, in the same year
- What we compared: the share of each doctor’s asthma inhaler prescriptions that were for Aerivant
- Adjusted for: specialty, state, number of patients and practice size
- Limits: Medicare patients only; we cannot see why a doctor chose a drug
Doctors who received no meals wrote 6 percent of their asthma inhaler prescriptions for Aerivant. Doctors who received one to three meals wrote 9 percent. Doctors who received four or more wrote 13 percent.
Lung specialists prescribed the drug more often than primary care doctors overall, which is expected, since they see harder cases. But the meal gap showed up within each specialty too.
What the company says
Pellridge Respiratory said in a statement that its meetings with doctors «provide accurate, up-to-date scientific information» and follow industry guidelines. It said Aerivant has advantages for some patients, including once-daily dosing, and that «prescribing decisions are made by physicians based on their clinical judgment.»
Dr. Hollis Gage, a pulmonologist in Ohio who has not taken industry meals since a hospital policy banned them nine years ago, said the pattern did not surprise her. «Nobody thinks they can be bought for a turkey sandwich,» she said. «That’s the point. It isn’t a bribe. It’s a relationship.»
Why it matters
The cost difference lands on patients and on Medicare. Older inhalers in the same class have generic versions that cost under $60 a month. For a Medicare patient in the coverage gap, the out-of-pocket difference can be several hundred dollars a year.
Earlier research has found the same link between small industry meals and prescribing for blood thinners, antidepressants and cholesterol drugs. A study by Dr. Amira Thibodeaux and colleagues at a West Coast medical school last year found that a single meal was associated with a measurable rise in prescribing of the promoted drug.
Some health systems ban meals from drug representatives. Most do not. Several doctors we contacted said they had never thought about it, and one asked us to send them their own numbers. We did.