Industry Money Undermines the Doctor-Patient Relationship

Patients expect that physicians base prescribing decisions solely on their patients’ individual medical needs and treatment preferences. However, a recent analysis by investigative journalists at the online media outlet ProPublica[1] indicates that the large sums of money pharmaceutical and medical device companies funnel to physicians too often play an inappropriate role in these decisions.

For their analysis, published March 17, ProPublica journalists wanted to know whether physicians who receive payments from the medical industry were more likely to prescribe brand-name drugs (instead of equivalent cheaper generic drugs) than those who did not.[2] To answer this question, they matched 2014 data on individual physicians across the U.S. from two public databases maintained by the Centers for Medicare and Medicaid Services: the Open Payments database and the Medicare Part D prescribing database.

The Open Payments database, which was mandated by the 2010 Physician Payments Sunshine Act and began operating in 2014, tracks all payments and gifts made by drug and medical device manufacturers to individual physicians.[3] The ProPublica analysis of information from this database included payments for speaking, consulting, travel and meals, as well as royalties, stock and gifts, but excluded payments for research. The Medicare Part D prescribing database compiles prescribing data by individual physicians and identifies whether brand-name or generic versions of drugs were prescribed.

ProPublica analyzed the records of physicians in the following five specialties: family medicine, internal medicine, cardiology, psychiatry and ophthalmology. For all five specialties combined, 74 percent of the 150,000 physicians in the Medicare Part D database for 2014 who were included in the analysis received at least one industry payment in 2014. For each specialty, as the amount of payment to a doctor increased from none to more than $5,000 per year, the average rate of prescribing of brand-name medications steadily increased. For example, among internal medicine physicians who received no industry payments, the average brand-name prescribing rate was 20 percent, compared with 30 percent for those who received more than $5,000 from companies. Even doctors who received just free meals from industry were more likely to prescribe brand-name drugs.

Financial relationships between physicians and industry can subtly and not so subtly influence the opinions and recommendations of health care providers. The new data from ProPublica provide further evidence that industry payments to physicians have a corrupting influence on medical practice.

Ultimately, the bottom-line financial interests of companies do not align with the best interests of patients. Physicians should refuse to accept gifts and payments from industry. For those who do not, patients should consider looking elsewhere for their medical care.

References

[1] Ornstein C, Jones RG, Tigas M. Now there’s proof: Docs who get company cash tend to prescribe more brand-name meds. ProPublica. March 17, 2016. https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs. Accessed April 18, 2016.

[2] Ornstein C, Jones RG. Matching industry payments to Medicare prescribing patterns: An analysis. March 2016. ProPublica. https://static.propublica.org/projects/d4d/20160317-matching-industry-payments.pdf. Accessed April 18, 2016.

[3] Sunshine law exposes vast industry payments to physicians. Worst Pills, Best Pills News. December 2014. /newsletters/view/933. Accessed April 18, 2016.