RENEE MONTAGNE, HOST:
There is a good chance your doctor gets some perks from pharmaceutical companies. It could be as little as lunch or it could be a big check for speaking fees. NPR's Alison Kodjak reports that a new study from ProPublica shows those financial relationships could affect the way doctors prescribe medications.
ALISON KODJAK, BYLINE: Doctors like to believe that payments from drug companies don't influence their medication decisions. But the new analysis points the other way.
CHARLES ORNSTEIN: The more money doctors receive from drug and device companies, the more brand-name medications they tended to prescribe.
KODJAK: That's Charles Ornstein, a reporter at ProPublica, which compared the payments to doctors from drug and device companies to prescribing habits. The pattern is important because generic drugs, when they're available, are usually cheaper, but Ornstein says prescribing lots of branded drugs isn't necessarily bad.
ORNSTEIN: There's a variety of reasons why a doctor may choose a brand-name drug over a generic. Some patients have tried a variety of generics and they haven't worked. And other patients have certain conditions like HIV and AIDS where there just aren't a whole lot of generic options.
KODJAK: Even when there are generics, some doctors believe the brand-name drug is better. Felix Tarm is one of them. He's an internist in Wichita, Kan., who specializes in treating patients with hypertension.
Tarm has been paid to make speeches about a blood pressure drug called Edarbi. It's in a class of medications called ARBs, angiotensin receptor blockers. Other drugs can bring down blood pressure just as much, but Tarm says Edarbi is best at protecting the kidneys.
FELIX TARM: It's a no-brainer to decide which ARB ought to be used.
KODJAK: Tarm has similar reasons for other drugs that he promotes. The ProPublica study shows he prescribes brand-name drugs at twice the rate of his peers, but...
TARM: I don't get any pay whatsoever for using the drug. Now, the converse is true. Many preferred provider organizations provide bonuses for the doctor to use a generic drug.
KODJAK: Tarm is close to retirement and doesn't draw any salary from his practice. He instead subsidizes it with his speaking fees that range from a couple of hundred to as much as $2,000.
Drug companies seek out people like Tarm because they can be influential when they speak to their peers, and they work hard to them. They visit their offices to talk about the drug. They might offer some samples, take a doctor to lunch and eventually ask them to make a speech.
The ProPublica database shows Tarm received almost $12,000 from drugmakers in 2014. But other doctors refused to take any payments at all, like Aaron Kesselheim, a doctor at Brigham and Women's Hospital in Boston. His practice refuses payments to avoid conflicts of interest.
AARON KESSELHEIM: If we know that a little bit of financial support can affect prescribing, it kind of makes logical sense to me that a lot of it can affect prescribing more.
KODJAK: In a statement, the Pharmaceutical Research and Manufacturers of America said that their surveys show doctors look at many factors when they decide which drugs to use, factors like patients' specific medical needs and articles in peer-reviewed journals.
Still, the close relationship between doctors and drug companies trouble some in the medical profession. Richard Baron is president of the American Board of Internal Medicine.
RICHARD BARON: It's common for people to believe that it doesn't influence their behavior, but I think there's plenty of evidence that it does.
KODJAK: He says there's extensive research on so-called gift exchange, the idea that if you get something from someone, you owe them something back.
BARON: There's enough literature about that to have every reason to believe that it would operate with physicians and drug companies the same way it would operate in primitive cultures, the same way it operates in a variety of social settings with which we are all familiar.
KODJAK: Baron says there may be good reasons that doctors work with drug companies, but it's important for them to see that their decisions could be influenced by those deals. Alison Kodjak, NPR News.
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