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Innovative Medicines Canada, which represents about 40 drug makers, said in a statement that its code of ethical practices prohibits members from providing gifts or other personal benefits.Jeff McIntosh/The Canadian Press
Doctors who receive gifts or payments from pharmaceutical companies end up prescribing more frequently, and choosing less suitable medications, a review of nearly a hundred medical studies has concluded.
The findings were released on Thursday in a Cochrane review, an analysis that aggregates results from previous health care research. “We found high-certainty evidence that gifts and payments have a harmful effect on prescribing appropriateness and are associated with higher volumes of prescribing,” the paper said.
The review looked at studies conducted in the United States and Europe, where researchers have access to databases documenting payments received by health care professionals. There was no data for Canada since pharmaceutical companies here are not required to declare what they give to physicians.
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Innovative Medicines Canada, an association that represents about 40 drug makers, said in a statement that its code of ethical practices prohibits members from providing gifts or other personal benefits.
The code, however, permits companies to offer “reasonable meals/refreshments” during promotional activities. It also allows them to compensate health care professionals for participating in activities such as speaking engagements, chairing meetings, advisory boards or market research.
“Canada and the U.S. operate under different regulatory and disclosure frameworks. These differences are important context when comparing practices between the two countries,” the association’s statement said.
However, Joel Lexchin, a professor emeritus at York University’s Faculty of Health and one of the review’s co-authors, said the findings of the Cochrane analysis could apply to Canada. “Based on the 45 years that I’ve been looking at these issues, it’s pretty clear to me the way that the drug companies promote their drugs here in Canada is the same as the way that they promote them in the United States,” he said in an interview.
Prof. Lexchin added that Ottawa should step in and make payment disclosure mandatory. “But the federal government has never shown any interest in doing this,” he said.
Alexandre Bergeron, a spokesperson for federal Health Minister Marjorie Michel, said that regulating physicians is a provincial and territorial jurisdiction.
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Ontario is the only province to have passed a law requiring companies to divulge their payments to health care professionals and organizations. The Health Sector Payment Transparency Act was enacted in 2017 under former Liberal premier Kathleen Wynne. However, it never came into force because its regulations hadn’t been finalized by the time Premier Doug Ford’s Conservatives took power in 2018.
Prof. Lexchin said it would be preferable to have a federal disclosure law, rather than provincial legislation. “Much, much more” data for the whole country would be available that way, he said.
The Cochrane review looked at 93 studies – 82 from the U.S. and others from France, the Netherlands, Denmark, Germany, Sweden and the United Kingdom. “The vast majority of the studies, all but one, showed that exposure to the promotional activity of gifts or payments made the prescribing less appropriate,” said the review’s senior author Lisa Bero, a University of Colorado Anschutz medicine professor.
Dr. Bero and another co-author, Barbara Mintzes, a University of Sydney pharmacy professor, spoke to reporters at a technical briefing on Tuesday.
They shared a graph from one study showing that the number of meals that doctors received from opioid manufacturers correlated with the number of doses they prescribed the following year.
The same pattern occurred with other classes of drugs, such medications for diabetes or blood pressure, Dr. Mintzes said. “This isn’t just an individual doctor-patient issue, and it’s certainly not just an issue of a few bad apples. It’s more of a systemic problem.”
Even “very small payments” influenced physicians to prescribe higher doses, beyond national guidelines, Dr. Bero said.
In the U.S., the Physician Payments Sunshine Act requires pharmaceutical companies to declare all payments to physicians. France has a similar public database, Transparence Santé.
The French data, for example, enabled researchers to analyze records for more than 41,000 family doctors, documenting how those who received gifts prescribed more.
Some Canadian companies voluntarily release their payment information. GSK Canada, for instance, made public a breakdown of the $18.9-million it paid in 2025 to health care professionals and corporations. Other manufacturers provide only the total sum they disbursed, with no further details.