ORLANDO — With drug companies and medical professionals growing closer over the past decade, many have wondered if the newly close relationship leads to doctors altering how they treat their patients.

According to the Orlando Sentinel, a study published in JAMA Internal Medicine has finally answered that question. The study documented a group of 280,000 doctors who received meals from pharmaceutical companies in 2013.

The study discovered that doctors were far more likely to prescribe brand-name drugs when offered free meals. However, what shocked observers was that it only took a few meals costing less than $20 to see a profound change in prescription rates.

“What was most surprising to me was that such small payments were associated with big differences in physician prescriptions,” said Colette Dejon, a study author and research fellow at the Center for Healthcare Value at the University of California at San Francisco. “It was previously thought it takes a certain amount of money to influence a doctor, and the current guidelines are written that way.”

The relationship has grown so close that in 2014 a reported $6.49 billion was spent on U.S. doctors and teaching hospitals by pharmaceutical companies.

One of the drugs that became more frequently prescribed once doctors began receiving free meals was ACE inhibitor, Benicar. When doctors received four or more pharmaceutical sponsored meals, Benicar saw a prescription rate rise to 4.5 times the pre-meal level.

Pharmaceutical companies refute these claims saying, “This study cherry-picks physician prescribing data for a subset of medicines to advance a false narrative.”

Field experts like Arthur Caplan, head of the ethics program of the Global Institute for Public Health at New York University, offer a rebuttal to claims that meals do not influence prescription decisions.

“Any gifting creates a sense of obligation,” said Caplan. “Small gifts attach themselves as marketing reminders. You get a chance to give your message.”

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