More than one-third of doctors say they yield to patient requests for brand name drugs

Doctors often bend to patient requests for brand name drugs even when there are equivalent and less expensive generic drugs available, a survey by researchers at the Mongan Institute for Health Policy published this week in JAMA Internal Medicine found.

Among 1,891 doctors surveyed on issues of professionalism, 37 percent said they sometimes or often prescribe a brand name drug upon patient request when a generic is available.

“By definition it’s a waste of money,” said Eric Campbell, a sociologist and professor of medicine with the Mongan Institute and lead author of the research letter. “The good news is that two-thirds of doctors aren’t doing this—are doing this very infrequently or not at all.”

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But half of all internal medicine doctors and psychiatrists said they would fill such a request. Other specialists were less likely to do so, the survey found, though prescribing may be a smaller part of their practice.

Older doctors and physicians in small independent practices were more likely to yield to such patient requests than their younger counterparts and those in larger or hospital-based practices.

Dr. Aaron Kesselheim, an internist at Brigham and Women’s Hospital who studies the costs and use of prescription drugs, said the survey results are not surprising.

Those patient requests “carry a lot of weight in part because a physician is trying to please their patient and in part because there’s a limited amount of time to get through everything, so it’s probably the easiest choice,” he said.

Kesselheim said it takes time to explain to a patient why a generic drug will work just as well. More education for physicians about how to handle such conversations could help, but marketing by pharmaceutical companies can be counteractive to such efforts.

The survey found that those doctors who say they sometimes or often meet with pharmaceutical industry representatives, in the name of staying up to date on the drug market, were more likely to prescribe a brand name drug that a patient requests. The pattern held for those who accept meals or gifts from industry representatives.

“It really appears that industry marketing works,” Campbell said.

The Legislature last year loosened a state ban on pharmaceutical companies buying gifts or meals for doctors, a change that was lobbied for by restaurant groups and opposed by patient advocates. The new rules allow for “modest” meals to be served during drug company presentations and do not prohibit alcohol or set a dollar limit.

Campbell, who has a master’s degree in adult education, said you don’t need to take people to restaurants and buy them food and alcohol to teach them what they need to know. But, he said, “that is in the curriculum for marketing.”

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