Sunlight is the best disinfectant, the saying goes. Yet public disclosure hasn’t kept most physicians from accepting compensation from drug and device makers.
Companies paid physicians at a steady clip following the federal government’s launch of the Open Payments disclosure tool in August 2013, according to a research note that looked at payments through December 2022.
During that period, the industry made a total of 85 million payments worth $12.1 billion. Among eligible physicians, 57% received at least one award.
For journalists, the finding is a reminder to inquire whether clinician sources have financial disclosures that might bias their views.
What the analysis shows
By law, drug and device manufacturers and group purchasing organizations must report payments and other “transfers of value” they make to clinicians and teaching hospitals. That includes compensation for consulting services, speaking fees, food and beverages, travel reimbursement, entertainment, education, gifts, grants, charitable contributions, and honoraria.
The median reported payment was $48 per physician, but a few physicians received awards in the multiple millions of dollars, the researchers found. Orthopedic surgeons received the greatest chunk ($1.36 billion) followed by neurologists and psychiatrists ($1.32 billion) and cardiologists ($1.29 billion).
The authors noted that the database relies on the accuracy of industry reporting and doesn’t include certain things like free product samples.
Another caveat: The study did not look at payments to advanced practice clinicians (APCs) such as nurse practitioners and physician assistants, which the database began to collect in 2021. A separate analysis of 2021 data found that physicians and APCs took payments at similar rates but physicians had significantly greater median payments.
Why it matters
Studies have consistently found relationships between payments and physician prescribing behavior, including the selection of inappropriate cancer drugs. One study found that physicians are more likely to implant cardiac defibrillators made by companies that pay them the most.
Industry payments have also been found to erode patient trust in individual physicians.
Not surprisingly, drugs and devices associated with the most payments tend to have high price tags (see chart).
Top drugs and devices associated with payments to physicians (2013-2022)
| Top drugs | Amount | Top medical devices | Amount |
|---|---|---|---|
| Xarelto (blood thinner) | $176.3 million | da Vinci Surgical System (robotic surgery system) | $307.5 million |
| Eliquis (blood thinner) | $102.6 million | Mako SmartRobotics (robotic surgery system) | $50.1 million |
| Humira (rheumatoid arthritis treatment) | $100.2 million | CoreValve Evolut (heart valve) | $44.8 million |
Some experts say even small amounts, such as a $25-catered lunch, can have influence.
“It’s about the time listening to and the time in personal contact with industry representatives that these dollars are a marker for,” Aaron Mitchell, M.D., a medical oncologist and assistant attending physician at Memorial Sloan Kettering Cancer Center in New York City, told Medscape Medical News.
Many physicians view collaboration with industry as an essential element in the development of products that can help their patients. However, there’s concern that these payments turn physicians into industry cheerleaders.
An author of the research letter, Andrew Foy, M.D., a cardiologist and associate professor in the department of medicine at Pennsylvania State University in Hershey, wrote in a blog that direct payments to individual physicians are only part of the story. Medical journals and conferences are awash with industry sponsorships.
Foy worried that the barrage of funding may produce “overly enthusiastic recommendations or guidelines from medical organizations to use new products when they have not been sufficiently tested, or where the evidence is not strong enough” to recommend them over older options or doing nothing.
He added that industry payments “have a way of tilting physicians sympathy toward industry,” exemplified when attendees at medical conferences “stand up and cheer after results are presented for ‘late-breaking’ research studies” even though benefits are usually very small.
Takeaways for journalists
Open Payments is a relatively reliable source of disclosures of physician-industry ties. Some companies have paid federal penalties for failing to fully report payments.
Disclosure in other forums is uneven at best. Studies have found significant gaps in compliance with medical journals’ requirements that authors disclose conflicts of interest, and one study found physicians almost never mention their industry relationships when commenting on Medicare national coverage determinations.
Timeliness is an issue, however. Open Payments posts data for the previous year on June 30, so information can be more than a year old (current data are for 2022). It’s always a good idea to consult other sources such as disclosures in research papers and conference presentations and ask clinicians directly if they have industry relationships.
Public awareness lags
ACHJ advocated for the creation of the Open Payments database in 2012 in order to give individuals, researchers and journalists easy access to reported payments.
However, although many journalists use Open Payments, some research suggests that the tool has not gained much traction with individual patients, who have the power to push back against physicians who take industry payments. By referring to Open Payments in their stories, journalists can increase public awareness.
An interesting experiment is happening in California, where a law took effect in 2023 requiring physician offices to notify patients about the Open Payments database. Consumer advocates in the state hope that greater use of the tool will empower patients to make more informed medical choices.
Examples of reporting using Open Payments
- Slippery Slope: $$ in, Diet Drugs Out, How Five Drugs Came to Market—MedPage Today story from 2015
- Top Cancer Researcher Fails to Disclose Corporate Financial Ties in Major Research Journals—ProPublica/New York Times story from 2018
- We Found Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies—ProPublica story from 2019
- Ten Doctors on FDA Panel Reviewing Abbott Heart Device Had Financial Ties With Company—KFF Health News story from 2024
