Almost every meal a drug rep buys your doctor is public record.
By Justin Yamashita, MSc. Benchtop, site, CRO: three levels of basic and clinical research, explained without spin by an oncology clinical trial project manager.
Look up your doctor in 2 minutes
Search "Open Payments" and open the free federal search site. Choose the search for a doctor.
Leave the search type on Individual Provider. Type your doctor’s first and last name, city and state, then tap Search the Data.
Open the listing. Read what each payment was for and how much, not just the total. No listing? Doctors with no payment in the past seven years don’t appear, so check the spelling first.
Know someone who'd want to look? Forward this to them.
Three things most people don't know about drug reps
Every line in the database starts as a receipt somewhere.
When a drug rep promotes a medicine, they must stick to the uses on its FDA approved label, the official prescribing information for that drug. Questions about other uses go to the company's medical team.
Paying a doctor to prescribe is a federal felony when Medicare, Medicaid or other government insurance pays for the drug.
What drug companies give doctors is searchable, for free, by anyone.
Ray's Kitchen Table
One name typed into a free federal website.
Maya has her keys in her hand when her dad calls her back to the kitchen table.
"Come look at this."
Ray has the laptop open and his reading glasses pushed up on his forehead. He's on Open Payments, the free federal website that lists what drug companies give doctors. He’s typed in one name: Dr. Okafor.
Maya reads over his shoulder. A handful of lunches. A few hundred dollars, spread over several years.
Ray taps the screen. "Who's buying my doctor lunch?"
Two minutes, one name, and you'll see what your doctor has been given. Send this to the person in your family who'd want to look.
Sam the Skeptic and Rooty the Researcher are sitting in, as always.
Sam rubs his hands together. "Here it comes. The bribe."
"Maybe," Rooty says. "Let's go see where those lines came from."
Charles's Day on the Road
Charles is a drug rep, a salesperson for a drug company. He sells a heart medicine that's already approved, and he calls on doctors' offices all over the county.
Morning. On his passenger seat sit two things: the slide deck his company approved, and the drug's prescribing information, the official label the FDA approved, with every use and every risk. That label is his script. He can't promote the medicine for anything it doesn't cover.
Think of the label as an owner's manual. Charles can only sell from the manual. Where the analogy bends: a doctor may still prescribe a medicine for a use outside the manual, called off label, if it's right for a patient. Charles just can't pitch it that way.
Midday. Lunch for the staff at Dr. Okafor's office: sandwiches, salads, a tray of cookies. Before he pulls out of the parking lot, he logs the receipt in his expense app, with the names of the doctors who ate. The record has to match the receipt, because his company reports what it spends on doctors to the federal government.
Sam leans over the seat. "So where's the envelope of cash?"
Rooty points at the phone. "There's the receipt."
Afternoon. At another practice, a doctor asks whether the heart medicine helps a kind of patient the label doesn't mention. Charles says he can't speak to that. He offers to have his company's medical team, the scientists who handle those questions, follow up.
End of day. A practice down the road has a sign on the door: no rep lunches. Charles respects it and drives on. He still believes a lunch buys him the only ten minutes a busy doctor will give.
Charles is a composite, built from what a rep we spoke with told us about the job. That rep told us some Florida offices refuse rep lunches entirely, and that from the rep's side, the meal is the best way to get time for an educational conversation.
Back at the Kitchen Table
The lines on Ray's screen started as receipts like the one Charles logged in that parking lot.
Sam frowns. "So no bribe."
"No bribe on this screen," Rooty says. "That's not the same as no question."
The Black Box Warning: The Missing Number
The number is the part that tells you what happened.
Tactic: The Missing Number.
Move 1. Announce it: "Dr. Smith took money from a drug company!"
Move 2. Leave out what the money paid for, and how much.
Move 3. Let a $14 lunch, research money for a hospital and a bribe all sound the same.
Put it this way. "He got paid by a bank" could mean a paycheck, a refund or a bribe. The amount and the reason are the story.
Where's Sam's Bar?
Sam wants to win this one. He's already writing the post in his head: Ray's doctor took drug company money.
"Where's your bar?" Rooty asks.
"What bar?"
"What it would take to change your mind. If one sandwich proves a bribe, your bar is in the sky, and nothing on that screen could ever clear it. That's a cynic. You doubted Dr. Okafor before you read a single line."
"And if I just figure he's fine?"
"Bar on the floor. That's a believer. A skeptic sets the bar before looking." Rooty taps the laptop. "So set it. What would make this a problem?"
Sam thinks. "Big consulting fees. Or lunches every week from the same company."
"Good bar. Now look."
Sam looks again. A handful of lunches. A few hundred dollars over several years.
"Doesn't clear it," Sam says. "I'm still keeping an eye on the salesman."
"That's the difference," Rooty says. "Cynicism doubts the person. Skepticism checks the claim. Now let's check the claims."
Small Doses special: the money claims, part 2 of 5. Three things you'll hear about drug reps and doctors, checked the skeptic's way.
1. "Doctors get a commission for every prescription"
What people say: "Drug companies pay doctors for every prescription they write."
What's partly true: Illegal schemes have happened.
The skeptic's question: Compared to what?
Compare it with a job where commissions are legal. A real estate agent gets a cut of every sale. A doctor can't. When Medicare, Medicaid or other government insurance pays for the drug, paying a doctor to prescribe breaks the Anti Kickback Statute, the federal law against paying for business in health care. It's a felony, with up to 10 years in prison and a $100,000 fine. There's no legal version.
Where the analogy bends: the agent's commission is legal, so it's written into the contract. The doctor's version is a crime, so when it happens, it's hidden. That's why these cases end in court.
And they have. In January 2020, the founder of Insys Therapeutics, an opioid maker, was sentenced to 66 months in prison, five and a half years. Federal prosecutors said the company's speaker programs, paid talks where doctors present a drug to other doctors, "were used as a vehicle to pay bribes and kickbacks." In July 2020, Novartis paid $678 million to settle a federal fraud lawsuit. That's more than $1.8 million for every day of a year. The government alleged its speaker events "served as nothing more than a means to provide bribes to doctors."
The cases are real. Cases like these are why the rules and the public database matter. Judge the person and the record, not the job title.
2. "Nobody tracks any of this"
What people say: "Nobody knows what drug companies give doctors."
What's partly true: Most people have never heard of the database.
The skeptic's question: Can I find the original, and does it say the same thing?
You can. The Physician Payments Sunshine Act, part of the 2010 health care law, requires drug and device makers to report what they give doctors, teaching hospitals and some other clinicians, like nurse practitioners. That covers meals, travel, speaking and consulting fees, education items such as textbooks, research money and ownership stakes.
It all goes into Open Payments. In 2025, companies reported $14.67 billion there, in 17.07 million records. Read one record a second, day and night, and you'd need more than six months. About 65 cents of every dollar was research money, which can pay a hospital or clinic to run a study.
Think of it as a bank statement for the relationship between a company and a doctor: what, when and how much. Where it bends: a bank statement doesn't tell you why, and neither does this.
Very small items are left out. In 2026, anything under $13.82 isn't reported, unless that company's total for the doctor that year passes $138.13. That's why we say almost every meal.
The three steps at the top walk you through a search.
3. "Reps buy doctors with gifts and trips"
What people say: "Reps hand out gifts and trips so doctors push their drugs."
What's partly true: Reps used to hand out pens, mugs and more.
The skeptic's question: Am I seeing the full picture, or only part of the evidence?
The drug makers' own code of conduct dropped the pens and mugs in 2009, along with entertainment. Since a 2022 update, a meal with a rep's presentation has to be modest, occasional and in the office or hospital. A rep we spoke with told us that for reps who follow the code, there's no quid pro quo, no this for that: a lunch doesn't buy a prescription. The same rep told us shady reps exist.
The code is voluntary, like a gym's house rules: the members agreed to it, but it isn't the law. Where the analogy bends: a gym can throw you out. The backstop here is the law above it, and the public record.
Now the part of the picture that's easy to skip. In a study of nearly 280,000 doctors, a single sponsored meal, averaging under $20, was linked to up to twice the odds of prescribing the brand name drug it promoted. A review of 36 studies found 30 linking industry payments to more prescribing in every analysis, and none finding only no link. That's association, not proof. Companies may also aim their lunches at doctors who already prescribe a lot.
No deal needed, and the numbers still move. So the record is worth reading, not just having.
Next Wednesday, part 3 of the money claims takes the doctor's side of that record, and asks the same question of supplement brands and the influencers they pay: who's paying, and can I see it?
Where Sales Ends and Research Starts
I'm Justin Yamashita, a senior project manager in oncology clinical research. In the open: I work in clinical research, so I have a professional stake in this industry, and research money is part of what's in that database. No company paid for, saw or approved this issue.
I've worked at research sites, as a remote monitor reviewing sites’ work, and on the project side. Across every one of those roles, one thing held: the people selling a drug weren't part of running the study. Reps don't enroll patients, don't see study records and don't decide which doctors get research money. Federal compliance guidance tells drug makers to keep research grants away from sales and marketing. If a rep asks about a study, the answer at the front desk is short: that's for the study team.
That's why one doctor's listing can hold two very different kinds of money. A rep's lunch is sales. A research payment usually pays for the work of running a study. Both sit under the same name.
Read which one it is before you decide what it means.
The Skeptic's Toolkit
The three questions this issue used:
2. Compared to what?
3. Can I find the original, and does it say the same thing?
6. Am I seeing the full picture, or only part of the evidence?
The full Skeptic's Toolkit.
Copy this
For the next time someone says "my doctor gets paid by drug companies":
"A Sunshine Act listing tells you a company paid for something. Check what it was, how much, and whether it went to research before you decide what it means." |
What this means for you
· Look up your own doctor in Open Payments. It takes about two minutes, and the three steps at the top show how.
· Read each line, not just the total. What was it for, and how much?
· If something surprises you, ask your doctor about it. Most will answer.
· Remember that research money and a sandwich look the same in a headline and very different in the record.
The Wall of Sams
Did you look your doctor up? What did you find, and did anything surprise you, in either direction?
Reply to this email or leave a comment on the newsletter. With permission, a few of your stories may show up in a future issue.
Seen a health claim that's bugging you? Send it to us. The ones that come up most become a Wednesday issue.
Send this to one person
If you looked your doctor up today, send this to one person who'd want to do the same.
Pick a line and use your own link below. It counts toward your Series 1 card.
To a parent: "There's a free government site that shows what drug companies give your doctor. This walks you through it in two minutes."
To the friend who's sure every doctor is bought: "Read claim 3. It doesn't let anybody off easy."
The Bridge
Some of the money in Open Payments is research money. It pays for clinical trials, the studies that test whether a medicine works and is safe, and it's listed under the doctor who leads the study.
If you or someone you love is looking for a trial, our registries page shows how to search. Looking commits you to nothing.
Clinical research needs this bridge to get us from drug discovery to drug availability for someone to get the next generation treatment. Without people aware of clinical trials, they could miss the window to enroll in a trial. The faster studies can generally enroll, the faster they can check whether the drug was safe, was effective, was better than the previous option. Help build the bridge by sharing this newsletter and information about clinical research. Be a part of clinical research by being a spokesperson for it.
Every claim sits somewhere on the bridge. The research money in a doctor's listing is part of how medicines cross it.
Try it yourself: see if you'd have caught this week's costume on your own.
The Skeptic Type quiz sorts you into your pattern in about two minutes.
Got Skepticism? runs any claim through the questions in the Skeptic's Toolkit, including the one from this issue: compared to what?
Stay in the Room shows you how to disagree without a fight so that you can talk to people about these difficult topics.
The quiz and both games play in your browser at Open Label Media, and I would love to see your results on social.
Work in clinical research, or want to? The Open Site File comes out every Tuesday. Its issue on who's who when industry visits a research site follows Charles from the other side of the sign in sheet. Get it by email:
Between issues, the free tools live on the site. The Field Guide has printable patient logs and the full Skeptic's Toolkit. If you or someone you love is looking for a trial, there's a walkthrough for finding one near you. And if you've ever wondered why clinical research has the rules it does, Version History tells that story. The tees and mugs that help support the work are in the shop.
The Receipts
1. CMS. Open Payments Search Tool.
2. CMS. Open Payments: Data Overview, Program Year 2025. Published 2026.
4. CMS. Open Payments: Natures of Payment.
5. 42 USC 1320a-7b, Criminal penalties for acts involving Federal health care programs (Anti-Kickback Statute). Cornell Legal Information Institute.
6. US Department of Justice, District of Massachusetts. Founder and Former Chairman of the Board of Insys Therapeutics Sentenced to 66 Months in Prison. January 23, 2020.
7. US Department of Justice, Southern District of New York. Acting Manhattan U.S. Attorney Announces $678 Million Settlement Of Fraud Lawsuit Against Novartis Pharmaceuticals For Sham Speaker Programs. July 1, 2020.
9. FDA. Responding to Unsolicited Requests for Off-Label Information About Prescription Drugs and Medical Devices. Draft guidance, December 2011.
10. Faegre Drinker. What? No More Pens? (PhRMA Code revisions effective January 2009). July 2008.
11. Loeb & Loeb. PhRMA Revisions to Code of Interactions Effective Jan. 1, 2022. August 2021.
12. DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. 2016;176(8):1114-1122. Summary: UCSF, Free Meal from Pharma: Doctors Are More Likely to Prescribe Brand-Name Drugs.
13. Mitchell AP, et al. Are Financial Payments from the Pharmaceutical Industry Associated with Physician Prescribing? A Systematic Review. Ann Intern Med. 2021;174(3):353-361.
14. HHS Office of Inspector General. Compliance Program Guidance for Pharmaceutical Manufacturers. 68 FR 23731, May 5, 2003.
For educational purposes only. Nothing in this newsletter is medical advice. Talk to your doctor before making any health decision.
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Disclosure: Root to Rx is published independently by Open Label Media LLC. Views expressed are personal views of Justin Yamashita and do not represent his employer or any affiliated organization. No employer resources or proprietary information are used. Every claim is sourced from publicly available materials.
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