Overall, the researchers pointed to various trends tearing away at doctor-industry relationships, such as policies that prevent medical faculty from joining speaker bureaus, laws forbidding doctors from receiving gifts, and even investigations led by Republican Senator Chuck Grassley from Iowa.

Is a declining relationship between providers and industry a good thing? The researchers say their study wasn't designed to answer whether PIRs are linked with higher health care costs. However, they note that in their survey PIRs were less common in lower-cost geographic areas, raising the possibility that companies would "market less aggressively in regions where many patients are impoverished and covered by Medicaid, which strictly restricts its formulary and use of brand-name products." The researchers also argued that, after controlling for practice and physician factors, doctors with at least one PIR are less likely to say they never prescribe brand-name drugs, which are costlier.

There are also caveats. The researchers warned that the survey could underestimate PIRs; because many view them negatively, it's possible doctors would be reluctant to admit to them in the survey. Also, it's possible that drug companies have simply switched to lobbying high-volume prescribers, thereby getting more bang for their PIR buck.

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