4 in 10 Docs Cave in to Brand-Name Drug Demands

4 in 10 Docs Cave in to Brand-Name Drug Demands

Antibiotic-Resistant-Crisis-thumbnailEven when generic drugs are available, approximately 4 of 10 physicians in practice more than 30 years “sometimes or often” give in to patients’ demands for brand-name drugs. This is compared with 31% of physicians in practice for 10 years or less.

Data taken from a national survey of 3,500 randomly sampled physicians across 7 specialties was published in this week’s JAMA Internal Medicine. The numbers suggest that the unnecessary healthcare system costs associated with this practice may be substantial.

Physicians who worked primarily in a solo or 2-person practice, received free food and/or beverages in the workplace (39% vs 33%) or drug samples (40% vs 31%), or met industry representatives to stay up to date (40% vs 34%) were more likely to yield to patients’ demands. Additionally, physicians in internal medicine (50%), psychiatry (50%), cardiology (44%), and family practice (39%) were more likely to prescribe brand-name drugs.

The researchers suggest that a potential intervention that could dramatically reduce this practice includes having a closed health system (such as the Veterans Health Administration). This would give the pharmacy primary control over these decisions, with override capability for rare situations when necessary (eg, allergy to generic additive).

Do you agree with these findings? Do you agree a closed health system is the answer?



  1. Are you suggesting that no brand name drugs be prescribed?
    If so, who would do the research required for any new drug or treatment? I guess you are satisfied that we now have all the drugs we will ever need and should not bother to look for new ways to treat disease.

  2. This is a marketing drive viewpoint.

    While I essentially always sign Rx’s as generic substitution allowed, the person who pays the premium, not the physician and definitely not the pharmacy or pharmaceutical manufacturer.

    Pharmacy’s love generics because they have a higher profit margin, but generics, as I have seen for years, infrequently live up to the same quality controls as the brand names.

    The Medical Letter did a nice study on this in the later 1990’s, comparing several batches of furosemide 40 mg tablets purchased from a variety of retail pharmacies around the US. Among the generic tablets they had analyzed, none contained the full 40 mg (the most expensive ingredient), less than half were within the legal limit, ≥32 mg and the rest were less than 40 mg of furosemide/tablet. The worst batch was ~6 mg/tablet.

    This analysis did not touch on the formulation of the tablets, which can also affect the absorption and efficacy of the medicinal tool.
    Furosemide is never fully absorbed, less so in the case of bowel edema, and is a very dose sensitive tool. So these issues are big, not minor.

    Buyer beware always applies.
    There is no such thing as fair; fairness is always in the eye of the beholder.
    And so life goes.


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