The medical field has long been wary of the influence of payments from pharmaceutical and medical device companies on physicians’ behavior. This is especially the case for the clinicians and researchers in oncology who serve on treatment guideline committees, as these guidelines commonly dictate the care patients receive in the United States.
So in an effort to increase the transparency around the financial relationships between health care providers and medical product manufacturers, Congress passed the Physician Payments Sunshine Act in 2010, which required manufacturers and group purchasing organizations to report such transactions to the Centers for Medicare and Medicaid Services.
Although the data on these financial ties have been scrutinized as early as 2013 — the first year for which the public could get a glimpse of these reports — the program will soon contain 7 full years of information. Once all data are collected for 2019, inquiring minds will finally get the opportunity to make conclusions about whether the public nature of the disclosures actually motivated physicians to accept less industry funding.
So far, preliminary analyses from the so-called “Open Payments” program have not been entirely positive.
In a much-discussed paper first published in Cancer in July 2019, researchers compared the disclosures of physicians serving as authors of the American Society of Clinical Oncology’s (ASCO’s) clinical practice guidelines with those found in the Open Payments database between August 2013 and June 2018.1
“The main point is that a lot of people report accurately, but there are some who don’t,” said Eitan Amir, MD, medical oncologist at Princess Margaret Cancer Centre in Toronto, Ontario, who was a coauthor of the Cancer paper. “That doesn’t mean they’re doing anything wrong,” emphasized Dr Amir. “It means they’re not being as transparent as they’re expected to be. Some payments were large, but for some [doctors] it might have been a $15 lunch they forgot about.”
In the study, 184 of 314 (59%) doctors involved in the creation of 26 clinical practice guidelines reported financial conflicts of interest. Of the 130 authors who did not disclose any payments, records for 71 of these individuals could not be found in Open Payments at all. But for the remaining 59 authors who supposedly had zero conflicts of interest and could be located in the Open Payments database, 55 of them (93%) were found to have actually received financial support from industry sources.
And among the 243 authors with verifiable financial conflicts, 34 received more than $1000 for nonresearch funding, and 19 received more than $5000 in payments not related to research endeavors. The conclusion: Transparency can be improved. “We’d like to see whether there should be additional mechanisms to see if disclosures are accurate,” he said.