US drug marketing: how does promotion correspond with health value?

The pharmaceutical industry uses a variety of techniques to promote its products to clinicians, including gifts and free food, advertisements, and detailing by company representatives. Although manufacturers might argue that drug promotion supports physician education, which in turn leads to more informed prescribing, studies have shown that greater contact with drug sales representatives is associated with an increased likelihood of prescribing brand name medications when cheaper alternatives exist.12 More recent studies have shown that payments from drug companies are associated with a greater likelihood of prescribing promoted drugs.345

In the United States, physicians have extensive financial relationships with the drug industry.67 However, since August 2013, the Physician Payments Sunshine Act requires that the industry publicly discloses all payments to physicians of $10 (£8; €9) or more or $100 on aggregate. This legislation led to the creation of the Open Payments Database, which archives all industry payments to individual physicians and teaching hospitals.8

Early analyses of the database show that numerous small gifts can often add up to large sums of money,910 potentially creating powerful incentives for physicians to prescribe selected drugs. Between August 2013 and December 2014, $3.53bn was paid to 681 432 physicians in the US by 1630 pharmaceutical companies to promote numerous drug products. We assessed the health “value” of drugs being most aggressively promoted to physicians to better understand implications of pharmaceutical promotion for patient care.