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.

The US Physician Payment Sunshine Act (also known as Open Payments) is a transparency statute signed into law as part of the Patient Protection and Affordable Care Act of 2010 (the ACA, also known as “Obamacare”). Under the law, drug, biologics, and medical device manufacturers must report payments made to doctors and teaching hospitals.

“The US took a huge step forward with the Physician Payment Sunshine Act, which requires drug companies to publicly report all gifts, meals, and payments to physicians,” said Colette DeJong, BA, of the Center for Healthcare Value at the University of California, San Francisco School of Medicine.

Open Payments has revealed tremendous amounts of industry money paid to physicians. An analysis of 2015 data from Open Payments revealed that nearly half (48%) of physicians received industry payments — worth $2.4 billion that year alone.1 Surgeons and men received higher payments than others.

The law has widespread support among those who study conflicts of interest in medicine.

“I believe the information about payments to physicians from industry should be a matter of public record, readily accessible to anybody who is interested,” said Harvey V. Fineberg, MD, PhD, president of the Gordon and Betty Moore Foundation in Palo Alto, California.

According to Dr Fineberg, disclosure is not always a sufficient remedy for conflicts of interest. “Physicians with a financial conflict of interest should not participate in standard setting or preparation of guidelines that affect use of the pertinent drugs or devices,” he said.

Even an ostensibly trivial gift — something as mundane as a free meal — might influence physicians in the clinic.2

“Most of the physicians who receive industry payments receive relatively small payments in relation to their annual earnings,” Dr Fineberg said. “Yet even small gifts produce feelings of reciprocity that can subtly, but predictably, influence medical choices.”

Even hematologist-oncologists' social media posts on Twitter might be associated with industry payments, according to a recent study.3

“The reason industry spends billions in payments to physicians is that these payments do, on average, influence choices in favor of the payer,” Dr Fineberg said. “Patients are entitled to have the professional opinion and advice of doctors untainted by external influences.”

A study of Open Payments and Medicare Part D Prescriber data found, for example, that oncologists who received payments from drugmakers were more likely to prescribe that manufacturer's drugs to patients with metastatic renal cell carcinoma (RCC; odds ratio [OR], 1.78; 95% CI, 1.23-2.57) and chronic myeloid leukemia (CML; OR, 1.29; 95% CI, 1.13-1.48).4

Another study of physician disclosures at a 2014 annual research meeting found a 35% “rate of inconsistency” between disclosed financial interests and data from the Open Payments database.5

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