TORONTO, Oct 8, 2026 – Doctors’ prescribing habits are heavily influenced by payments, gifts, and free meals from pharmaceutical companies, leading to more expensive, less appropriate and more drugs being prescribed, a new Cochrane review finds. This can seriously harm both individual patients and health systems.

Pharmaceutical companies use a variety of strategies to market and promote their drugs. This can include one-on-one visits by sales reps to doctors' offices and hospitals, gifts and payments including for example paid meals, travel costs to conferences, entertainment, consulting fees, honoraria for participation in advisory boards, and advertising.

For all new medicines, pharmaceutical companies target prescribers with offers of free meals and other gifts and payments. These payments and gifts lead to prescribing of the company's promoted drug, which may not always be needed or be the most appropriate or affordable medicine for each patient.

Less appropriate prescribing and higher medicine costs

The review included 93 studies involving a number of different study types. Almost all of these studies observed real-world prescribing patterns rather than running controlled experiments. The majority of the studies (88 per cent) came from the United States, in part because the requires pharmaceutical companies to publicly report details of all payments to doctors, which are compiled in a publicly searchable and analyzable database.

However, co-author 91��ɫ Professor Emeritus Dr. Joel Lexchin, who has studied drug prescribing in Canada for the past 40 years, points out that the ways drugs are prescribed in Canada generally follows what the U.S. does.

“This review puts to rest the myth that doctors prescribing benefit from exposure to drug company promotors. Overwhelmingly, we found in the three dimensions of prescribing that we examined – appropriateness, cost and quantity – that prescribing deteriorates,” says Lexchin of the Faculty of Health.

Analyzing millions of prescribers, the authors grouped industry interactions into three distinct categories to examine how each one affects a doctor's prescribing habits. These were advertising and education, gifts and payments, and free samples. The authors also looked at conflict-of-interest policies as a mitigation strategy.

Advertising and education, such as sales rep visits, seemed linked to prescribing that was less clinically suitable and pricier, with fairly strong evidence that it also drove up prescription volume.

The largest and most consistent body of evidence covered gifts and payments. Gifts and payments were also linked to less appropriate prescribing, more prescriptions, and probably increased costs.

The evidence was too sparse or weak to draw clear conclusions on free drug samples and whether promotion affects hospitals’ approved formularies, although what little exists suggests it might.

“Overall, when doctors have more contact with drug company promotion, prescribing tends to become less appropriate, more frequent, and more expensive”, says study author Dr Lisa Bero from the University of Colorado Anschutz, USA. “This is problematic for a number of reasons and it matters because it directly affects patient care. These less appropriate, more expensive drugs can have fewer benefits or more side-effects than alternatives, or simply be unnecessary in the clinical context.”

The overprescription of opioids is the most infamous example of pharmaceutical companies’ promotion exaggerating benefits and minimizing harms. This review found that even inexpensive meals increased opioid prescribing and that the more payments a doctor received from opioid manufacturers, the more likely they were to prescribe dangerously high opioid doses. The widespread inappropriate overprescribing of opioids has led to an epidemic of addiction and deaths from overdoses.

“Patients should be offered the most appropriate treatment for their condition, based on clinical evidence not industry marketing,” adds Dr Bero. “The opioid crisis in North America was perhaps the most egregious example of inappropriate over-prescribing, but this was not an isolated incident. It was high-profile due to the significant harms involved, but the systems that enabled it are unfortunately considered business-as-usual within the industry. Interactions between pharmaceutical companies and prescribing physicians are widespread, and the harms they cause are rarely so visible.”

More meals paid for, more drugs prescribed

Notably, the research shows a clear dose-response relationship between paid-for meals and inappropriate prescriptions. The more meals a doctor received from a company, the more of the company's drug they prescribed. This was true for a range of different types of drugs, from drugs for high blood pressure and cholesterol to antidepressants and opioid painkillers.

The authors also point out that this practice is seen as normal and unproblematic in the medical field.  

“It's very common for doctors to receive free meals from companies,” says lead author, Dr Barbara Mintzes from the University of Sydney, Australia. “Doctors often think that this is trivial and doesn’t influence them, that they ‘can’t be bought for the price of a sandwich’, but the data shows this is an effective marketing strategy. The more free meals a doctor receives, the more likely they are to prescribe less appropriate or more expensive drugs.”

Restricting industry interactions may improve prescribing

Some hospitals and medical centres have rules or institutional restrictions in place, also known as conflict-of-interest policies, to limit how much contact industry reps can have with doctors or what gifts or samples they are allowed to provide. The review found that these can mitigate the negative impact of pharma strategies on doctors’ prescribing habits.

“It’s encouraging to see that robust conflict-of-interest policies in place tended to be effective,” Dr Mintzes says. “The data shows that they probably improve prescribing appropriateness and possibly reduce the number of prescriptions.”

While this review found that drug promotion negatively influences prescribing within a broad range of drugs and clinical settings, the authors wish to emphasize that this is not about a few "bad apples”, but about improving the system and a key positive finding is that strict conflict-of-interest policies are a way forward.

was published in the Cochrane Database of Systematic Reviews.  

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For further information, contact:  

Sandra McLean, 91��ɫ, sandramc@yorku.ca

Mia Parkinson, Cochrane Press Office, mparkinson@cochrane.org o�� press@cochrane.org,  +44 20 4591 8310  

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TORONTO, Nov. 27, 2025 — 91��ɫ welcomes 91��ɫ Region’s decision to make a significant contribution of $25 million to support the new School of Medicine set to open to students in 2028. 

The $25 million commitment will help fund the physical infrastructure and development of the School of Medicine, which will be built in the Vaughan Healthcare Centre Precinct, alongside the Cortellucci Vaughan Hospital. 

 “On behalf of 91��ɫ, I want to express my deepest gratitude to 91��ɫ Regional Council members and Chairman Jolliffe for this extraordinary investment in the future of health care,” said Rhonda Lenton president & vice-chancellor, 91��ɫ. “Your commitment of up to $25‑million for 91��ɫ’s new School of Medicine in the Vaughan Healthcare Centre Precinct will help us train the next generation of primary care physicians where they are needed most. This partnership reflects our shared vision to improve health outcomes, strengthen community well‑being, and build a resilient regional economy. Together, we are creating a model of integrated education and care that will serve 91��ɫ Region and Ontario for generations to come.”  

 This significant milestone represents ongoing positive momentum as the University ramps up work to engage local physicians, collaborate with health care and tech sector partners in the medical school’s future service area such as Mackenzie Health, Oak Valley Health, Southlake Health, and the (OCI).   

 “91��ɫ Region is proud to support this important investment in training future physicians right here in our own community. By contributing $25 million to 91��ɫ’s new School of Medicine, we are helping ensure that families across our communities have better access to the care they need, closer to home. This partnership reflects our shared commitment to strengthening the health and well-being of residents and building a future where everyone in 91��ɫ Region can thrive,” said Eric Jolliffe, 91��ɫ Region Chairman and CEO.  

 91��ɫ Region’s contribution builds on existing commitments from the Government of Ontario to fund the startup costs associated with establishing the medical school. The land for the new building has been generously donated by the City of Vaughan.    Together, these commitments strengthen momentum for the medical school, which is a much-needed part of the Ontario government’s expansion of medical education designed to address local physician shortages, enhance access to primary care, and support a long-term, sustainable health-care system.   

About the 91��ɫ School of Medicine

The 91��ɫ School of Medicine will be explicitly structured around a community-based primary care model, emphasizing inter-professional collaboration, equity, and patient-centred practice. Its location within the Vaughan Healthcare Centre Precinct — next to Cortellucci Vaughan Hospital — will facilitate strong connections between clinical training, research, and community health services.

About 91��ɫ

91��ɫ is a modern, multi-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change and prepare our students for success. 91��ɫ's fully bilingual Glendon Campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education. 91��ɫ’s campuses in Costa Rica and India offer students exceptional transnational learning opportunities and innovative programs, while at the Markham Campus, innovation, technology, entrepreneurship, and industry collaboration are built into every program. 91��ɫ’s new School of Medicine, the first Canadian medical school to focus on community-based primary health-care education, will welcome its first cohort in September 2028.

Media Contact: Yanni Dagonas, 91��ɫ Media Relations, 647-468-7850 yannidag@yorku.ca

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TORONTO, June 4, 2025 – If data used to train artificial intelligence models for medical applications, such as hospitals across the Greater Toronto Area, differs from the real-world data, it could lead to patient harm. A new study out today from 91��ɫ found proactive, continual and transfer learning strategies for AI models to be key in mitigating data shifts and subsequent harms.

To determine the effect of data shifts, the team built and evaluated an early warning system to predict the risk of in-hospital patient mortality and enhance the triaging of patients at seven large hospitals in the Greater Toronto Area.

The study used GEMINI, Canada’s largest hospital data sharing network, to assess the impact of data shifts and biases on clinical diagnoses, demographics, sex, age, hospital type, where patients were transferred from, such as an acute care institution or nursing home, and time of admittance. It included 143,049 patient encounters, such as lab results, transfusions, imaging reports and administrative features.

“As the use of AI in hospitals increases to predict anything from mortality and length of stay to sepsis and the occurrence of disease diagnoses, there is a greater need to ensure they work as predicted and don’t cause harm,” says senior author 91��ɫ Assistant Professor of 91��ɫ’s School of Health Policy and Management, Faculty of Health, a member of Connected Minds and a faculty affiliate at the Vector Institute.

“Building reliable and robust machine learning models, however, has proven difficult as data changes over time creating system unreliability.”

The data to train clinical AI models for hospitals and other health-care settings need to accurately reflect the variability of patients, diseases and medical practices, she adds. Without that, the model could develop irrelevant or harmful predictions, and even inaccurate diagnoses. Differences in patient subpopulations, staffing, resources, as well as unforeseen changes to policy or behaviour, differing health-care practices between hospitals or an unexpected pandemic, can also cause these potential data shifts.

“We found significant shifts in data between model training and real-life applications, including changes in demographics, hospital types, admission sources, and critical laboratory assays,” says first author Vallijah Subasri, AI scientist at University Health Network. “We also found harmful data shifts when models trained on community hospital patient visits were transferred to academic hospitals, but not the reverse.”

To mitigate these potentially harmful data shifts, the researchers used a transfer learning strategies, which allowed the model to store knowledge gained from learning one domain and apply it to a different but related domain and continual learning strategies where the AI model is updated using a continual stream of data in a sequential manner in response to drift-triggered alarms.

Although machine learning models usually remain locked once approved for use, the researchers found models specific to hospital type which leverage transfer learning, performed better than models that use all available hospitals.

Using drift-triggered continual learning helped prevent harmful data shifts due to the COVID-19 pandemic and improved model performance over time.

Depending on the data it was trained on, the AI model could also have a propensity for certain biases leading to unfair or discriminatory outcomes for some patient groups. 

“We demonstrate how to detect these data shifts, assess whether they negatively impact AI model performance, and propose strategies to mitigate their effects. We show there is a practical pathway from promise to practice, bridging the gap between the potential of AI in health and the realities of deploying and sustaining it in real-world clinical environments,” says Dolatabadi.

The study is a crucial step towards the deployment of clinical AI models as it provides strategies and workflows to ensure the safety and efficacy of these models in real-world settings.

“These findings indicate that a proactive, label-agnostic monitoring pipeline incorporating transfer and continual learning can detect and mitigate harmful data shifts in Toronto’s general internal medicine population, ensuring robust and equitable clinical AI deployment,” says Subasri.

The paper, , was published today in the journal JAMA Network Open.

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You’ve just been given a prescription for a new drug from your doctor. Your doctor told you why she was prescribing the medication, gave you its name and some information about common side-effects. Your pharmacist is also available to help you use the medication properly, but you want more details and general information.

You’d also like to know things such as how quickly the drug was approved by Health Canada, whether there have been any recent safety warnings about the drug, how the drug compares to other medications for the same condition and what information Health Canada took into consideration when it approved the drug.

You’re aware that a general internet search may yield unreliable information, so you decide to look at what’s on the various Health Canada websites.

General information: The product monograph

Every drug that’s approved by Health Canada comes with what’s known as a product monograph (PM).  a PM “is a factual, scientific document on the drug product that, devoid of promotional material, describes the properties, claims, indications, and conditions of use for the drug, and that contains any other information that may be required for optimal, safe, and effective use of the drug.”

PMs can be downloaded from the  after you type in either the brand or generic name of the drug. Most of the document is written in language that would be hard for the average consumer to understand, but at the end there is typically a seven- or eight-page section of consumer information that offers more detailed information about issues such as safety, what the drug is used for and when you should avoid using it.

While the PM has to be approved by Health Canada, it is actually written by the company marketing the drug, and the actual contents are often subject to negotiation. It’s also not clear how often a PM is revised. All Health Canada says is that  when there is new safety information or when there are new uses of the drug, but there is no timeline given for how quickly those revisions need to be done.

Safety information

The PM will give you aggregate safety information, but it doesn’t tell you how many times doctors, consumers and manufacturers have reported safety concerns or if Health Canada has issued a safety warning.

For the reported safety concerns, you need to go to the .

For Health Canada’s health warnings, you’ll need to go to the . However, when you get there, there are no instructions about how to do a search so it’s trial and error and hopefully you’ll find what you need.

Information about clinical trials

Clinical trials are the studies that companies have to do before a drug can be marketed. But these studies usually only include a small subset of people who have the condition that the drug’s designed to treat. They often  groups such as the elderly, children, women who might become pregnant and people taking multiple other drugs.

If you want to know if the drug you have been prescribed has been tested on people similar to you, you can read section 7.1 of the  which gives details about the clinical trials. Information about the age and sex of patients in the trials is there, but unfortunately Health Canada only discloses that information in a .

How well does the drug work?

Will the drug make you feel better? Drugs are sometimes approved using what are called hard clinical endpoints, such as do you live longer and/or is your quality of life better. But drugs are also approved based on surrogate endpoints.

Surrogate endpoints are measures of things like changes in blood chemistry, blood pressure or how hard you can blow into a machine. These are supposed to predict what matters to patients — things like survival and quality of life — and sometimes they do as with drugs for HIV/AIDS that lower viral load, . But often surrogate endpoints don’t. For example, only a minority of  on the basis that they shrunk the size of the tumour, a surrogate endpoint, actually helped people live longer.

The Summary Basis of Decision documents will tell you whether clinical or surrogate endpoints were used, and it turns out that  approved by Health Canada between 2012 and 2022 used surrogate endpoints. So, how much benefit you will get might be questionable.

How quickly was the drug approved?

You might want to learn about how long it took Health Canada to approve the drug. There are studies showing that the  once it is on the market.

Information about how fast a drug was approved used to be available by writing to publications@hc-sc.gc.ca for annual reports, and using the information in those reports to calculate review times. But in August 2022, an unannounced decision was made to cancel the annual reports. So, as of now, there is no information covering the period after March 31, 2022. It’s unclear if the annual reports will be resumed.

How does one drug compare to another?

You might notice that the drug you’ve been prescribed for your problem is not the same one that your friend was prescribed for the identical problem. You may want to know which drug, on average, does a better job.

The  used to rank the additional therapeutic value of new drugs compared to existing ones on a scale from breakthrough to slight/no therapeutic value. Those rankings were done by an  and published each year in the PMPRB’s annual report. At least they were up until the long-delayed , which didn’t come out until February 2024. That report did not contain any rankings and the PMPRB has not said that publicly available information about rankings is going to come back.

Orphan drugs

If you have an  (one that affects fewer than one in 2,000 people) you often don’t have very many, or even any, treatment options. In those cases, you will want to know when new drugs are available that might help you.

Starting in 2018 Health Canada published an annual report that listed the new orphan drugs that it approved. But the ; since then, there have not been any new editions. So, now there is no new easily available information about new orphan drugs.

Finding out safety and effectiveness information about drugs shouldn’t be a hit and miss affair. Health Canada needs to do a much better job of providing all the information that concerned patients (and their caregivers) need in order to make sure that patients get the best possible results from the drugs that they use.

By 91��ɫ Professor Emeritus Joel Lexchin, Faculty of Health.

This article is republished from .

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