Do drug company gifts change what your doctor prescribes? A huge review says yes

$15.90.

That is what one American doctor found next to his own name when he looked himself up. It was the total value of food drug companies had given him since 2004. He laughed about it online. A resident replied that he was listed for a $25 sandwich.

It sounds harmless. A sandwich cannot buy a doctor.

But a review published on 8 October by Cochrane, the group known for weighing up medical evidence, says the pattern is real. Across 93 studies and millions of prescribers, more contact with drug company promotion went with prescribing that was less suitable, more frequent and more expensive.

"Overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive," says Dr Lisa Bero of the University of Colorado Anschutz, one of the authors.

Doctors and pharmacists online have been fighting about it ever since. Some were angry, some were defensive, and a few went straight to look up their own names.

Do drug company gifts really change what doctors prescribe?

The review looked at three kinds of influence. Most of the studies watched real prescribing in the real world, rather than running trials. 88% of them came from the United States.

Gifts and payments are the clearest case. That is the free lunch, the paid dinner, the flight to a conference and the speaking fee.

The lead author, Barbara Mintzes of the University of Sydney, puts it plainly. Doctors cannot be bought "for the price of a sandwich," she says. But the data shows free meals work as marketing.

How much do drug companies pay doctors?

Why does so much of the evidence come from America? Because America publishes the money.

A law passed in 2010, known as the Sunshine Act, forces drug and device companies to report what they give to doctors. Since 2013 the payments have gone into a public database called Open Payments.

A 2024 study in the medical journal JAMA added it all up. Between 2013 and 2022, companies paid US doctors $12.1 billion. Of 1.4 million doctors, 57% got at least one payment.

The money was very uneven, though.

So the typical doctor got less than the cost of a family pizza night over ten years. A small group at the top got more than most people earn in a lifetime. The JAMA authors say a small number received sums often over $1 million.

Photo: Wellcome Collection / Wikimedia Commons, CC BY 4.0

Can a free sandwich really change a prescription?

This was the fight in the comments.

One paediatrician wrote that he will not even eat the bagels reps bring to the office. A lawyer who said he works on Medicaid fraud, which is cheating America's health plan for poorer people, was blunt. "This is happening constantly and yes it works," he wrote.

Another person said their lung doctor had received more in gifts than a middle-class salary. Others compared it to the opioid crisis, when painkiller makers marketed hard to doctors in the US.

And one line got repeated again and again. If gifts did not work, drug companies would have stopped paying for them years ago.

None of this makes doctors crooks. The worry is simpler. A rep who brings lunch every month is also the person who talks up the newest drug. When that doctor writes the next prescription, the name that comes to mind first may be the one that came with the sandwich.

Is it fair to blame doctors?

Not all of them, and many doctors pushed back hard.

Some said newer drugs often really are better. A rep may be the first person to tell a busy doctor about one. Others said reps are a real source of education, especially in small towns far from big hospitals.

And remember the median. Most US doctors got under $50 over a decade. A $15.90 lunch bill is not a bribe.

The review has limits too. Most studies watched real life rather than running trials, so they show a strong link, not proof of cause. Almost nine in ten were American.

But the authors found good news. Hospitals and medical schools with strict conflict-of-interest rules, such as limits on gifts and rep visits, probably saw better prescribing. Mintzes calls that encouraging.

Photo: U.S. Air Force photo by Airman 1st Class Karina Lopez / Wikimedia Commons, Public domain

What about the UK, the EU and South Africa?

Every country handles this differently.

In South Africa, the Medicines and Related Substances Act says no one may supply medicine "according to a bonus system, rebate system or any other incentive scheme". Drug marketing to health workers is also covered by an industry code, run by the Marketing Code Authority. Rising medicine costs feed straight into what medical aids charge every year.

In the UK, drug companies follow the industry's ABPI Code. They publish payments through a database called Disclosure UK, but doctors are only named if they agree.

Across much of Europe, the industry runs similar disclosure codes. Some countries, such as France, have government websites too.

None of these is as open as America's system, where nearly every payment is listed by name.

How do I look up what my doctor got from drug companies?

If your doctor practises in the US, it takes about five minutes.

1. Go to openpaymentsdata.cms.gov, the official US government site. It is free and you do not need an account.
2. Type your doctor's name into the search box. You can narrow it by city or state.
3. Click their profile. You will see payments by year and by company.
4. Look at the type of payment. Food and drink, travel, consulting and speaking fees are all listed separately.
5. Check which drugs the payments were linked to. Then compare that with what you were prescribed.

Nurse practitioners and physician assistants are listed too, not only doctors.

A small number usually means a few office lunches. That alone does not mean much. A big number tied to the exact drug you take is worth a conversation.

What should I ask my doctor?

You do not need to accuse anyone. Two calm questions are enough.

Why this drug, and not another one? And is there a generic that works just as well?

A good doctor will be happy to answer. Doctors are human, and humans respond to small kindnesses. That is why drug companies spent $12.1 billion on US doctors in ten years, and it is why you are allowed to ask. Big reviews keep changing how we see everyday medicine. One found dancing had the biggest effect on depression of any exercise, and another took a hard look at ADHD and autism diagnoses. This one is about your prescription.

The free lunch is never really free. Now you know where to find the bill.