The Challenges of Tracking and Interpreting Medical Industry Payments

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The role of payments to hospitals and physicians is not well understood, despite attempts to quantify them.
The role of payments to hospitals and physicians is not well understood, despite attempts to quantify them.

The medical industry's sometimes-murky relationships with opinion leaders are a source of concern and research, but tracking payments and assessing the actual influence of pharmaceutical dollars on physicians can be a challenge.

The US Centers for Medicare & Medicaid Services (CMS) Open Payments program database was a much-awaited transparency mechanism for shining a public light on drug industry payments to physicians and teaching hospitals. Under the Affordable Care Act, companies are required to report research funding, travel, speaking, and consulting fees, gifts and meal reimbursements to the program; CMS now compiles those reports for public disclosure on the Open Payments database once a year.

Citing an analysis of data from Open Payments, a team of researchers at the University of North Carolina (UNC) at Chapel Hill recently reported in JAMA Oncology that 86% of the physicians and researchers who help to develop National Comprehensive Cancer Network (NCCN) cancer care guidelines received money from drug and medical device companies.1

The study authors reviewed all payments reported in 2014 for NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) authors serving on 4 different expert panels: breast, colon, prostate, and non-small-cell lung cancer.

Most industry payments for NCCN experts (about $29 million) came in the form of research funding. But another $1.25 million were “general” payments: money for travel, meals, speaking fees, and so forth. For 2014, Open Payments detailed $7.49 billion in industry payments made to nearly 620,000 physicians; that figure climbed to $7.52 billion in 2015.2

General payments to NCCN panelists averaged $10,000 but ranged as high as $106,859, the authors report.

“I think our results highlight just how prevalent industry relationships are among key thought leaders in oncology,” said senior study author Stacie Dusetzina, PhD, of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill. “The high amount of research payments is not completely surprising, as many oncologists are engaged in conducting industry-sponsored drug trials.”

NCCN relies on twice-annual self-reporting by its Guidelines panelists, limiting industry payments to the panelists and their dependents to less than $20,000 a year from any single company and less than $50,000 a year from all industry sources. Panel chairs and vice-chairs are not allowed to participate in promotional activities for industry, like serving on company speakers' bureaus.

Eight of the 125 panelists whose payments were analyzed exceeded those limits.

“We ask people to disclose money they have actually received,” said Joan McClure, MS, senior vice president of clinical information and publications at NCCN. “Coffee or travel reimbursement is not money that comes to a panel member. Those are ways of facilitating the sharing of information rather than a benefit to the panel member.”

NCCN also excludes payments to NCCN member institutions to encourage research.

After its review of Open Payments data, however, NCCN removed some panel members who did not meet the network's conflict-of-interest rules.

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