Pharmaceutical industry payments, gifts and promotional activities are associated with less appropriate prescribing, a higher volume of prescriptions and increased costs, according to a new Cochrane systematic review.
Published in the Cochrane Database of Systematic Reviews, the review — Pharmaceutical industry information and promotional strategies aimed at prescribers — analysed 93 studies examining the relationship between pharmaceutical company interactions and prescribing behaviour.
Of these, 82 were conducted in the US, with the remaining 11 covering the UK and other European countries.
The findings indicate that gifts and payments from pharmaceutical companies increase inappropriate prescribing and prescription volumes and likely increase prescribing costs.
Advertising and educational activities may also contribute to inappropriate prescribing and higher costs.
The authors also found that organisational conflict-of-interest policies that restrict or manage interactions between pharma companies and clinicians probably improve prescribing appropriateness and may reduce prescription volumes.
UK pharmaceutical transparency under scrutiny
Responding to the findings, Dr Piotr Ozieranski from the University of Bath's Department of Social & Policy Sciences highlighted the implications for UK pharmaceutical industry transparency.
Ozieranski said the concern was not necessarily that clinicians consciously exchanged prescriptions for benefits, but that normalised relationships with pharmaceutical companies could create an unconscious obligation to reciprocate.
He warned that the review's predominantly US-based evidence should not be interpreted as indicating that the UK is immune to similar effects.
In the US, the Physician Payments Sunshine Act underpins the Open Payments database, which provides public information about financial relationships between pharma and medical device companies and healthcare professionals.
The system has enabled researchers to investigate associations between industry payments and prescribing patterns.
In the UK, the Association of the British Pharmaceutical Industry (ABPI) operates Disclosure UK, a publicly accessible database of payments and benefits in kind made to healthcare professionals and organisations by companies covered by its Code of Practice.
However, Ozieranski argues that the industry's self-regulatory approach leaves important gaps in transparency.
According to figures cited by Ozieranski, pharma companies disclosed £647.3m in UK research and development payments in 2025, representing approximately 70% of the £929.6m in total disclosed transfers of value that year.
These research payments are distinct from non-research payments, which include activities such as consultancy, advisory work, speaking engagements and event sponsorship.
Their scale nevertheless raises questions about how financial relationships across the pharma sector are recorded and scrutinised.
Calls for stronger conflict-of-interest policies
Ozieranski also highlighted previous research finding that professional organisations, including Royal Colleges, received almost £100m in promotional payments between 2015 and 2021.
He argued that stronger institutional policies restricting pharma industry interactions could help protect prescribing decisions from commercial influence.
The Cochrane authors similarly concluded that policies managing or limiting promotional interactions may improve prescribing appropriateness, although they called for further research into the effects of these relationships on patient health.
For those in the pharma sector, the findings renew scrutiny of how promotional activities and relationships with healthcare professionals are governed.
Greater transparency and robust conflict-of-interest policies could help ensure that industry engagement supports clinical decision-making without compromising prescribing quality.
Companies may therefore need to consider not only whether payments and promotional activities meet disclosure requirements, but also how engagement is structured, monitored and assessed for potential conflicts of interest.
Clear internal policies and transparent reporting could help demonstrate that commercial relationships are managed responsibly and prescribing decisions remain grounded in clinical evidence.
