Industry Payments to Physicians: Confronting Conflicts of Interest

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Though imperiled by efforts to repeal the Affordable Care Act, the federal Open Payments transparency program is helping to expose industry payments to physicians.
Though imperiled by efforts to repeal the Affordable Care Act, the federal Open Payments transparency program is helping to expose industry payments to physicians.

A study of 19 non-oncology academic medical centers found, however, that restricting pharmaceutical company representatives' access to physicians (sales visits known as “detailing”) led to “modest but significant” declines in prescribing of drugs promoted by those representatives for most (6 of 8) drug classes.6

Lead study author Ian Larkin, PhD, of the University of California, Los Angeles, and coauthors reported that at centers with detailing restriction policies, there were significantly lower rates of detailed-drug prescribing for sleep disorders, gastroesophageal reflux disease, attention-deficit/hyperactivity disorder, antidepressants, anti-hypertensives, and lipid-lowering drugs.

The study's findings “highlight our responsibility to our patients to develop sensible restrictions on drug marketing,” Ms Dejong said. “One of the most common types [of drug marketing] is bringing in free lunch and giving physicians a short presentation on their companies' brand-name drugs.”

Between 2006 and 2012, many academic medical centers instituted policies to restrict these types of marketing visits by drug representatives, allowing Dr Larkin's team to assess how detailing affects prescribing.

In addition to the association of detailing restrictions with lower rates of prescribing certain drugs, the team found a “corresponding increase in the use of non-promoted drugs, most of which are inexpensive generic medications with low copays,” Ms DeJong noted.

“Right now, drug companies are the only group pounding the pavement to teach doctors about new drugs. Yet they have a financial conflict of interest and they pitch only brand-name drugs, not generics. Without support, it can be extremely time-consuming for physicians to find out what drug is most cost-effective for their patient, or whether a new brand-name drug is truly better than a time-tested generic.

“We've made huge progress, but we have farther to go to achieve full transparency in physician-industry relationships.”

References

  1. Tringale KR, Marshall D, Mackey TK, Conner M, Murphy JD, Hattangadi-Gluth JA. Types and distribution of payments from industry to physicians in 2015. JAMA. 2017;317(17):1774-84. doi: 10.1001/jama.2017.3091
  2. Steinbrook R. Physicians, industry payments for food and beverages, and drug prescribing. JAMA. 2017;317(17):1753-4. doi: 10.1001/jama.2017.2477
  3. Tao DL, Boothby A, McLouth J, Prasad V. Financial conflicts of interest among hematologist-oncologists on Twitter. JAMA Intern Med. 2017;177(3):425-7.
  4. Mitchell AP, Winn A, Dusetzina S. Pharmaceutical industry payments and oncologist drug selection. J Clin Oncol. 2017;35(suppl; abstr 6510). doi: 10.1200JCO.2017.35.15_suppl.6510
  5. Hannon CP, Chalmers PN, Carpiniello MF, Cvetanovich GL, Cole BJ, Bach BR Jr. Inconsistencies between physician-reported disclosures at the AAOS Annual Meeting and industry-reported financial disclosures in the Open Payments database. J Bone Joint Surg Am. 2016;98(20):e90.
  6. Larkin I, Ang D, Steinhart J, et al. Association between academic medical center pharmaceutical detailing policies and physician prescribing. JAMA. 2017;317(17):1785-98. doi: 10.1001/jama.2017.4039
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