Doctors make cheap dates, or so a study published Monday by JAMA Internal Medicine seems to suggest. Last month, ProPublica found that physicians who receive money from drug companies and medical-device-makers are more likely to prescribe brand-name drugs over virtually identical — but much cheaper — generic alternatives. The JAMA study affirms that research, finding that doctors who accept a single $20 meal from a pharmaceutical company are more likely to recommend branded drugs to their patients than those who never receive a free lunch.
The analysis focused on four drugs covered by Medicare part D: the cholesterol-lowering Crestor, the high-blood-pressure treatments Benicar and Bystolic, and the antidepressant Pristiq. Looking at the prescription habits of roughly 280,000 doctors who received industry-sponsored meals — which were worth less than $20 on average — the researchers found that doctors who accepted one free meal courtesy of Crestor were 18 percent more likely than other physicians to prescribe the brand-name drug over its low-cost alternative. For Benicar, Bystolic, and Pristiq, the increased probabilities were 52, 70, and 118 percent, respectively.
And the more meals a doctor received, the more likely he or she was to make Medicare pay for the more expensive drug. Doctors who received four meals courtesy of Allergan, the drugmaker behind Bystolic, were 540 percent more likely to prescribe the beta blocker.
In a sense, the study’s findings aren’t too surprising — we’ve known that free food makes human beings more responsive to a sales pitch ever since the first homo sapiens went on a date in the African savanna. Still, the fact that doctors’ medical decisions can be influenced by such meager offerings testifies to the way corruption can take root at a level beneath awareness: It’s unlikely that any physician consciously decided to trade their professional integrity for one glorious night at Olive Garden.
“Any gifting creates a sense of obligation,” Arthur Caplan, who heads the ethics program at NYU’s Global Institute for Public Health, told Bloomberg. “Small gifts attach themselves as marketing reminders. You get a chance to give your message.”
This insight appears just as relevant to the realm of politics. JAMA’s findings suggest that a politician can be corrupted by donors without ever intending to be: Exposure to a benefactor’s message — combined with our species’ innate inclination toward norms of reciprocity — may be enough to tilt the scales.