24 November 2020

Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing?: A Systematic Review

Publication: Annals of Internal Medicine
Volume 174, Number 3



Financial payments from the drug industry to U.S. physicians are common. Payments may influence physicians' clinical decision making and drug prescribing.


To evaluate whether receipt of payments from the drug industry is associated with physician prescribing practices.

Data Sources:

MEDLINE (Ovid), Embase, the Cochrane Library, Web of Science, and EconLit were searched without language restrictions. The search had no limiting start date and concluded on 16 September 2020.

Study Selection:

Studies that estimated the association between receipt of industry payments (exposure) and prescribing (outcome).

Data Extraction:

Pairs of reviewers extracted the primary analysis or analyses from each study and evaluated risk of bias (ROB).

Data Synthesis:

Thirty-six studies comprising 101 analyses were included. Most studies (n = 30) identified a positive association between payments and prescribing in all analyses; the remainder (n = 6) had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association. Payments were associated with increased prescribing of the paying company's drug, increased prescribing costs, and increased prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association; 25 assessed and found evidence of a dose–response relationship.


The design was observational, 21 of 36 studies had serious ROB, and publication bias was possible.


The association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.

Primary Funding Source:

National Cancer Institute.

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Supplemental Material

Supplement. Supplementary Material


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Information & Authors


Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 174Number 3March 2021
Pages: 353 - 361


Published online: 24 November 2020
Published in issue: March 2021




Aaron P. Mitchell, MD, MPH
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Renee L. Gennarelli, MS
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Johanna Goldberg, MSLIS
Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (J.G.)
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Deborah Korenstein, MD
Memorial Sloan Kettering Cancer Center, New York, New York (A.P.M., N.U.T., R.L.G., S.C., S.M.T., L.A.D., D.K.)
Grant Support: By Memorial Sloan Kettering Cancer Center Support Grant P30 CA008748 from the National Cancer Institute.
Reproducible Research Statement: Study protocol: See the Supplement. Statistical code and data set: Not applicable.
Corresponding Author: Aaron P. Mitchell, MD, MPH, Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017; e-mail, [email protected].
Current Author Addresses: Drs. Mitchell, Chimonas, and Korenstein; Ms. Trivedi; Ms. Gennarelli; and Ms. Tabatabai: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017.
Ms. Goldberg: Medical Library, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
Dr. Diaz: Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
Author Contributions: Conception and design: A.P. Mitchell, R.L. Gennarelli, S. Chimonas, L.A. Diaz Jr., D. Korenstein.
Analysis and interpretation of the data: A.P. Mitchell, R.L. Gennarelli, S. Chimonas, D. Korenstein.
Drafting of the article: A.P. Mitchell, N.U. Trivedi.
Critical revision of the article for important intellectual content: A.P. Mitchell, S. Chimonas, L.A. Diaz Jr., D. Korenstein.
Final approval of the article: A.P. Mitchell, N.U. Trivedi, R.L. Gennarelli, S. Chimonas, S.M. Tabatabai, J. Goldberg, L.A. Diaz Jr., D. Korenstein.
Statistical expertise: R.L. Gennarelli.
Administrative, technical, or logistic support: A.P. Mitchell, N.U. Trivedi, R.L. Gennarelli.
Collection and assembly of data: A.P. Mitchell, N.U. Trivedi, R.L. Gennarelli, S. Chimonas, S.M. Tabatabai, J. Goldberg, D. Korenstein.
This article was published at on 24 November 2020.

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Aaron P. Mitchell, Niti U. Trivedi, Renee L. Gennarelli, et al. Are Financial Payments From the Pharmaceutical Industry Associated With Physician Prescribing?: A Systematic Review. Ann Intern Med.2021;174:353-361. [Epub 24 November 2020]. doi:10.7326/M20-5665

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