Drug company gifts carry influence over prescribing

Clinical takeaway: Check a promoted drug against independent evidence and cheaper alternatives before prescribing it. 

Drug companies spent more than $250 million on meals for US clinicians in 2022. Many prescribers believe a catered lunch or a dinner after a talk has no bearing on what they prescribe.  Earlier reviews tied industry contact to higher prescribing and costs. This evidence synthesis analyzes meals, rep visits and free samples. 

Doctors who took industry gifts or payments were linked to prescribing more of the promoted drug in 67 of 71 comparisons. In one ophthalmology analysis, paid physicians gave a median 53.6% of their injections as aflibercept or ranibizumab, costlier than similarly effective bevacizumab, versus 16.5% among unpaid peers. Physicians paid by long-acting insulin makers wrote an adjusted average of 57.8 more long-acting insulin prescriptions the following year than similar unpaid physicians. Prescribing was also less appropriate and costlier among paid physicians. 

Meals alone showed a gradient across seven drug classes, among them statins, antidepressants and long-acting insulin. The more meals a physician received, the larger the share of prescriptions written for the promoted drug. The median opioid-related gift or payment was $13, a size the authors associate with low-value gifts such as meals. Physicians who received any were more likely to prescribe high daily opioid doses than those who received none. 

Sales representative visits were linked to more prescriptions and, less firmly, to less appropriate and costlier prescribing. Evidence on free samples was too thin to support a conclusion. Institutional limits on industry contact were linked to more appropriate prescribing, though only two studies addressed it, both on psychiatric drugs. 

The review tallied the direction of findings across 93 studies through January 2025, most of them cross-sectional or cohort analyses. Sixty-two examined payments or gifts, largely by linking US Open Payments records to Medicare prescribing data. 

None of the 93 studies tracked whether the extra or costlier prescriptions changed how patients did. The authors also call for research on which conflict-of-interest restrictions work best. 

"The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs," says Barbara Mintzes, PhD, a pharmaceutical policy researcher at the University of Sydney and a joint first author of the review. 

Source: Mintzes B, et al. (2026 Oct 8) Cochrane Database Syst Rev. Pharmaceutical industry information and promotional strategies aimed at prescribing