Doctors take (a lot of) money from industry

April 15, 2024

Patients and policymakers have long been worried about potential conflicts of interest where physicians are prescribing drugs or other treatments and are getting funding or payments from drug companies or medical device companies. Two recent stories validate this worry.

Researchers reported in JAMA Network Open last month that physicians had received $12.1 billion in funding or payment from pharmaceutical and medical device companies from mid-2013 to 2022. More than half of physicians received at least one payment. The average physician received less than $1000, although a small number of physicians received more than $1 million dollars. The researchers had access to data on physicians only. Orthopedists were paid the most, and the top 0.1% of orthopedists were paid $4.8 million over this time period. The top 0.1% of cardiologists, dermatologists, rheumatologists, ophthalmologists, and hematologist-oncologists were also paid more than $3 million.

The drugs associated with the highest payments to physicians were Xarelto (Rivaroxaban, $176 million), Eliquis (Apixaban, $103 million), and Humira (Adalimumab, $100 million), and the top medical devices were two surgical robot companies and a device used in nonsurgical treatment of failing aortic valves.

These payments to physicians are not all “bad.” In many instances, physicians did important work for these payments; for instance, many conducted company-sponsored research. In other instances, they attended lectures or workshops arranged by the pharmaceutical or medical device company and were not paid anything at all, but the cost of delivering the educational session was attributed to them. Still, there is excellent evidence that pharmaceutical payments influence physician medical decisions.

KFF Health News reported this week that ten of 14 physicians on an FDA advisory panel reviewing a medical device to stop leakage from a different heart valve had received payments from the manufacturer. In many instances the payment was close to $200,000. Again, some of these payments were to the physician’s employer (a laboratory or a hospital). The physician with the largest amount of device company funding was the lone vote saying that the benefits of this device did not exceed its risks. It’s possible that all these physicians divulged their industry payments to the FDA, which retains the ability to issue a waiver if it wants to have a physician with a conflict participate in one of its advisory committees. Such a waiver was not given for any of the ten with potential conflicts identified by KFF Health News. KFF used the Open Payments database from the Center for Medicare and Medicaid Services to identify these potential conflicts.

Implications for employers:

• A central national database to identify potential conflicts of interest provides valuable information; providers should always disclose conflicts of interest.

• Carriers can query the Open Payments database if they see unusual provider activity. However, providers that perform research are likely to have some potential conflicts.

• The FDA example shows that providers do not always make decisions in accordance with the interests of those who have provided them with some financial support.

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Tomorrow: Biosimilars haven’t lowered out-of-pocket costs (yet)