The shockingly low price of virtue

A wonderful bit of dialogue sometimes attributed to George Bernard Shaw and sometimes to Winston Churchill goes as follows:

Shaw: Madam, would you sleep with me for a million pounds? Actress: My goodness, Well, I’d certainly think about it. Shaw: Would you sleep with me for a pound? Actress: Certainly not! What kind of woman do you think I am?! Shaw: Madam, we’ve already established that. Now we are haggling about the price.

I thought of this when reading about a study published today in JAMA Internal Medicine: Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries, by Colette DeJong and others  (sent to me by friend of the blog Scott Killingsworth). As noted in the introduction, by way of background: “Physician-industry relationships—including sponsored meals and promotional speaking fees—are at the center of an international debate, intensified by recent transparency efforts in the United States and the European Union. In the United States, in the last 5 months of 2013, 4.3 million industry payments totaling $3.4 billion were made to more than 470 000 physicians and 1000 teaching hospitals. Although some argue that industry-sponsored meals and payments facilitate the discussion of novel treatments, others have raised concerns about their potential to influence prescribing behavior” (citations omitted).

The study was based on “Cross-sectional analysis of industry payment data from the federal Open Payments Program for August 1 through December 31, 2013, and prescribing data for individual physicians from Medicare Part D, for all of 2013” and the results were stunning: “As compared with the receipt of no industry-sponsored meals, we found that receipt of a single industry-sponsored meal, with a mean value of less than $20, was associated with prescription of the promoted brand-name drug at significantly higher rates to Medicare beneficiaries.”

Of course, this study has powerful ramifications for the life sciences industry. But, the implications presumably are relevant to any conflict of interest regime (as Scott noted in his email to me).

As well, these results are further proof of the oft-cited (at least in this blog) behavioral ethics learning that should be part of C&E messaging generally: we are not as ethical as we think. Indeed, there may be no better proof of it than this study.