Hanna Kuprevich/ Alamy Stock Photo
Promotional interactions between pharmaceutical companies and clinicians, including gifts and payments, are likely “associated with harmful outcomes”, a Cochrane review has suggested.
Publishing the findings of the review, entitled ‘Pharmaceutical industry information and promotional strategies aimed at prescribers’ in the Cochrane Database of Systematic Reviews on 9 October 2026, the authors highlighted that such gifts were associated with “inappropriate prescribing”, an increase in the quantity of prescriptions and “probably” an increase in prescription costs.
Gifts and payments were considered to include food and drink, consultancy payments, payments to cover travel expenses, and conference and other educational expenses.
The authors analysed 93 studies of pharmaceutical company promotion to prescribers. Of these, 82 studies were conducted in the United States, while 11 studies were conducted in the European Union or the UK.
The review looked at a variety of promotional behaviour, such as advertising and education, gifts and payments, free samples and conflict‐of‐interest policies. The authors also analysed how these were associated with consequent prescribing activity.
Of the 62 studies that included evidence around gifts and payments, the results of 10 studies — covering 2.9 million prescribers — revealed that these were associated with decreased prescribing appropriateness compared with receiving no or fewer gifts and payments.
The findings of the review also showed that of the 62 studies that included evidence around gifts and payments and prescribing appropriateness, none were from the UK.
The authors also noted that 39 studies — covering 3.9 million prescribers — had evidence of an increased quantity of prescriptions. In addition, they highlighted that gifts and payments were found to be likely associated with increased prescribing costs, which was based on evidence from 25 studies, covering 2.5 million prescribers.
The evidence across all types of promotional activities “raises strong concerns about the relationship between pharmaceutical industry promotional interactions and prescribing appropriateness and volume”, the authors said.
They added that the findings “support the importance of conflict‐of‐interest policies as an intervention to reduce clinicians’ exposure to promotional interactions, both during professional education and in clinical practice”.
Piotr Ozieranski, reader at the Department of Social and Policy Sciences, University of Bath, said: “The risk is not that doctors consciously exchange prescriptions for a free meal but that social relationships between the pharmaceutical industry and doctors become normalised, and, as the report says, create an ‘unconscious sense of obligation to reciprocate’, which may contribute to less appropriate, more frequent and more costly prescribing without clinicians experiencing themselves as compromised.
“Although this review focuses mainly on the United States, the scarcity of evidence from the UK should not be taken as evidence that industry payments do not influence prescribing here too.”
Unlike the United States, “the UK has pursued a voluntary system of self-regulation that allows companies to manage their own disclosures”, he continued.
Ozieranski added: “In light of the evidence presented in the Cochrane review, it is especially regrettable that the upcoming UK government guidance on drug company payment disclosure is likely do little to establish a data infrastructure similar to the one existing in the United States.
“This makes it even more difficult to introduce stronger conflict-of-interest policies advocated by the authors of the review — after all, you can’t regulate what you can’t see.”
Amit Aggarwal, medical director for the Association of the British Pharmaceutical Industry (ABPI), commented: “In the UK, NICE [National Institute for Health and Care Excellence] guidance and local formulary restrictions play a key role in shaping prescribing options. Company marketing must follow the ABPI’s strict code of practice, which goes beyond the law and requires information given to healthcare professionals to be fair, accurate and evidence-based.
“Gifts are prohibited, and hospitality to healthcare professionals is subject to specific, robust standards and reporting mechanisms.
“Research commissioned by the ABPI in 2024 found that hospitals engaging in industry partnerships are up to two-and-a-half times more likely to follow NICE recommendations for prescribing clinically and cost-effective medicines more closely, compared to hospitals that do not. Appropriate use of medicines closer to NICE guidelines was, in turn, associated with better outcomes for patients in the areas of care studied, keeping their conditions under better control.”
Read more: ‘Tip of the iceberg? The industry payments to medicines experts‘
