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    White coat notes

    Cheaper drugs often lose out

    Excerpts from the Globe’s health care blog.

    Doctors often bend to ­patient requests for brand name drugs even if there are equivalent and less expensive generic drugs available, according to a survey by ­researchers at Mongan ­Institute for Health Policy , published this week in the journal JAMA Internal Medicine.

    Among 1,891 doctors surveyed, 37 percent said they sometimes or often prescribe a brand name drug upon patient request when a generic is available.

    “By definition, it’s a waste of money,” said Eric Campbell, a sociologist and professor of medicine with the institute and lead author of the research letter.


    “The good news is that two-thirds of doctors aren’t doing this — are doing this very infrequently or not at all.”

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    But half of internal medicine doctors and psychiatrists said they would fill such a request. Other specialists were less likely to do so, the survey found, though prescribing may be a smaller part of their practice.

    Older doctors and physicians in small independent practices were more likely to yield to such patient requests than their younger counterparts and those in larger or hospital-based practices.

    Dr. Aaron Kesselheim, an internist at Brigham and Women’s Hospital who studies the costs and uses of prescription drugs, said the survey is not surprising.

    Those patient requests “carry a lot of weight, in part because a physician is trying to please their patient and in part because there’s a limited amount of time to get through everything, so it’s probably the easiest choice” to fill them, he said.


    Kesselheim said it takes time to explain why a generic drug will work just as well. More education for physicians about how to handle such conversations could help, he said, but marketing by pharmaceutical companies can counteract such efforts.

    The survey found that doctors who say they sometimes or often meet with pharmaceutical industry representatives — in the name of staying up to date on the drug market — were more likely to prescribe a brand name that a patient requests.

    The pattern held for those who accept meals or gifts from industry representatives.

    The Massachusetts Legislature last year loosened a state ban on pharmaceutical companies buying gifts or meals for doctors, a change that was lobbied for by restaurant groups and opposed by patient advocates.

    Accountable care list in Massachusetts grows

    The Centers for Medicare & Medicaid Services announced the creation of 106 more accountable care organizations Thursday.


    Among them were nine groups based in Massachusetts or with some operations here, including organizations ­affiliated with Metro West Medical Center, Baystate Health, Lahey Health, Winchester Hospital, and Cambridge Health Alliance.

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