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A University of Bath researcher has warned the UK is “not immune” from prescribing doctors being influenced by pharmaceutical companies through “commercial relationships”. 

Responding to a new Cochrane review on promotional strategies used to influence doctors’ prescribing patterns in different countries, Dr Piotr Ozieranski from the University of Bath’s social & policy sciences department 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 US, the scarcity of evidence from the UK should not be taken as evidence that industry payments do not influence prescribing here too.”

The Cochrane review looked at 82 studies carried out in the USA and 11 carried out in the UK and continental Europe. It assessed evidence of four types of interactions: advertising and education; gifts and payments; free samples and conflict of interest policies.

The authors of the review said: “Because of the studies' methods, we cannot say that pharmaceutical marketing and promotion caused changes to doctors' prescribing.

“But we are confident that inappropriate prescribing was higher among doctors who receive gifts and payments and that they wrote more prescriptions than doctors who did not receive gifts and payments.

“The studies also showed a consistent pattern: the more interactions doctors had with pharmaceutical companies, the less appropriate their prescribing was and the more prescriptions they wrote.”

Dr Ozieranski said that in contrast to the US, where the Sunshine Act “mandates the collection of high-quality data” on the possible connections between industry payments and prescribing patterns, the UK has adopted “a voluntary system of self-regulation that allows companies to manage their own disclosures”.

This has led to a “huge transparency gap” and “a lack of disclosure of payments related to research on drug company products” the academic said, adding: “In 2025, these payments amounted to £647.3m, equivalent to 70 per cent of all payments made that year in the UK by pharmaceutical companies.”

He added that enforcement mechanisms are stronger in the US, where companies may face financial penalties, in contrast to the UK where “the worst that can happen for an offending company is a public reprimand by the self-regulatory body”.

Dr Ozieranski commented: “Therefore, in the UK it is extremely difficult for patients, researchers, regulators or NHS organisations to assess whether commercial relationships are influencing clinical practice.

“Separately, we have found that professional organisations, including Royal Colleges, received almost £100m in promotional payments between 2015 and 2021.

“This is important because institutional conflicts of interest policies that restrict financial interactions with the industry were highlighted by the authors of the review as having positive effects on healthcare integrity.”

He said it was “regrettable” that upcoming UK Government guidance on payment disclosure “is likely do little to establish a data infrastructure similar to the one existing in the US,” commenting: “You can’t regulate what you can’t see.”