Could a free lunch or a consulting payment influence which medications a doctor prescribes? A major international review suggests that financial relationships between pharmaceutical companies and healthcare professionals may affect prescribing decisions, potentially leading to unnecessary treatments, higher healthcare costs and risks to patient safety.

The Cochrane review, conducted by an international research team that included University of Toronto researchers, examined more than 93 studies involving millions of prescribers. Researchers investigated the effects of pharmaceutical marketing activities, including sales representative visits, educational promotions, free drug samples, gifts, meals and financial payments. They found that physicians exposed to these practices were more likely to prescribe promoted medications, with industry interactions also linked to inappropriate prescribing.

Quinn Grundy, an associate professor at the University of Toronto’s Lawrence Bloomberg Faculty of Nursing and one of two Canadian contributors to the review, says pharmaceutical marketing is widespread internationally. Multinational drug companies employ similar promotional strategies across different healthcare systems, making industry influence a global concern.

In the United States, where pharmaceutical companies must publicly disclose payments to physicians, more than half of licensed doctors have received some form of industry payment, including complimentary meals. Grundy notes that companies often target physicians whose prescribing practices offer the greatest potential financial return, although many doctors choose to maintain their independence from industry promotion.

The review included no Canadian studies, partly because Canada lacks a comprehensive system for tracking pharmaceutical industry payments to physicians and nurse practitioners. Nevertheless, Grundy says other Canadian surveys and qualitative research suggest that financial incentives and complimentary meals are likely common among healthcare prescribers.

Beyond concerns about unnecessary medication use, pharmaceutical marketing may increase healthcare spending. Physicians influenced by industry promotion may prescribe expensive brand-name medications when equally effective, lower-cost alternatives are available, potentially increasing expenses for healthcare systems and patients.

The researchers also examined whether institutional conflict-of-interest policies could reduce pharmaceutical industry influence. Evidence suggested that restrictions on interactions between healthcare professionals and drug companies, particularly within medical schools and teaching hospitals, were associated with reduced prescribing or more appropriate medication choices.

Grundy argues that protecting professional independence requires stronger organisational policies rather than relying solely on individual clinicians. Healthcare institutions, professional associations and educational organisations should establish safeguards while ensuring prescribers have access to independent, evidence-based medical information.

The concern extends beyond physicians. Separate research using American payment disclosure data indicates that nurse practitioners and clinical nurse specialists are also targets of pharmaceutical promotion. The researchers emphasise that safeguarding prescribing decisions requires healthcare-wide action to protect professional integrity, promote appropriate treatment and ensure that patient well-being remains the priority.

More information: Barbara Mintzes et al, Pharmaceutical industry information and promotional strategies aimed at prescribers, Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD013423.pub3

Journal information: Cochrane Database of Systematic Reviews Provided by University of Toronto