1
|
Harlianto NI, Harlianto ZN. Health Care Industry Payments to Editorial Board Members of Major Neurosurgery Journals Between 2017 and 2022. Neurosurgery 2024; 95:816-824. [PMID: 38587376 PMCID: PMC11377092 DOI: 10.1227/neu.0000000000002934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/31/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Financial conflicts of interest between editorial board members and industry could lead to biases and impartial editorial decisions. We aimed to evaluate the frequency, amount, and characteristics of payments to editorial board members of neurosurgery journals over a 6-year period. METHODS In this cross-sectional study, editorial board members were derived from the top 10 neurosurgery journals based on Google Scholar metrics. The Open Payments database by the Centers for Medicare and Medicaid Services was accessed to evaluate industry payments to editorial board members from 2017to 2022. Descriptive analyses were performed on payment data, adjusted for inflation using the consumer price indices. RESULTS We included 805 editorial board members. After excluding duplicate names, 342 (53.9%) of 634 had received payments between 2017 and 2022. Eight of 10 journals had more than 50% of editorial board members listed in the Open Payments database. Between 2017 and 2022, the total number of payments to editorial board members was $143 732 057, encompassing $1 323 936 in research payments, $69 122 067 in associated research funding, $5 380 926 in ownership and investment interests, and $67 905 128 in general payments. General payments decreased from $13 676 382 in 2017 to $8 528 003 in 2022. Royalties ($43 393 697) and consulting ($13 157 934) contributed the most to general payments between 2017 and 2022. Four journals had a percentage increase in total payments, whereas general payments decreased for 6 journals. CONCLUSION Around 54% of editorial board members of neurosurgical journals received industry payments between 2017 and 2022. We identified journal-specific trends in industry payments and highlighted the importance of transparency and disclosure of financial conflicts of interests for neurosurgery journals.
Collapse
Affiliation(s)
- Netanja I Harlianto
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht , the Netherlands
| | | |
Collapse
|
2
|
Harlianto ZN, Harlianto NI. Evaluating industry payments to editorial board members of otolaryngology journals. Am J Otolaryngol 2024; 45:104501. [PMID: 39178699 DOI: 10.1016/j.amjoto.2024.104501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE To evaluate the extent of payments from medical device and pharmaceutical companies to editorial board members of leading otolaryngology journals. METHODS Editorial board members of the top 10 otolaryngology journals from Google Scholar rankings were identified in this cross-sectional study. Payments between 2017 and 2022 were identified via the Open Payments Database from the Centers for Medicare and Medicaid Services. All payment data was adjusted for inflation in 2022 US dollars. Descriptive analyses were performed and journal websites were evaluated for individual editor disclosures. RESULTS Out of 581 board members, 306 (53 %) received industry payments between 2017 and 2022, median journal percentage 55 % (interquartile range: 26.5 %-73.5 %). A sum of $45.8 million was paid out between 2017 and 2022, comprising $32.0 million in associated research funding, $1.2 million in research payments, $1.4 million in ownership and investment interests, and $11.2 million in general payments. The largest general payments were made out for "services other than consulting and speaking" ($3.9 million), "consulting" ($3.8 million), "travel and lodging" ($0.99 million), "education" ($0.87 million), "royalty or license" ($0.56 million), and "food and beverage" ($0.55 million). Individual editor disclosures were only available for International Forum of Allergy and Rhinology (9 % of all included editors). CONCLUSIONS Industry payments to editors of otolaryngology journals are not uncommon. We highlight the need for improved reporting of individual editor disclosures for transparency to journal readers and for minimizing biased editorial decisions.
Collapse
Affiliation(s)
| | - Netanja I Harlianto
- University Medical Center Utrecht & Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
3
|
Summerville L, Boas SR, Wee C, Isbester K, Kumar A. Evaluation of Conflict of Interest in Consulting Fee Payments in Plastic Surgery and Related Specialties. Plast Reconstr Surg 2024; 153:259-267. [PMID: 37199402 DOI: 10.1097/prs.0000000000010606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND The Physician Payments Sunshine Act was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments constitute a large proportion of these financial relationships. The authors hypothesized that there are discrepancies among industry-derived consulting payments to medical and surgical specialties. The purpose of this study was to evaluate the distribution of consulting fee payments to plastic surgery and related specialties. METHODS This cross-sectional study used the publicly available Centers for Medicare & Medicaid Services Open Payments Program database for 2018. Consulting fee payments to physicians practicing in dermatology, internal medicine, neurosurgery, orthopedic surgery, otolaryngology, and plastic surgery were isolated and analyzed to identify discrepancies in consulting payments among these specialties and within plastic surgery. RESULTS A total of $250,518,240 was paid in consulting fees to specialties analyzed, with the largest average payment made to orthopedic surgeons and neurosurgeons. Nearly half of physicians were paid at least $5000 for consulting fees in 2018. Most payments were not associated with contextual information. Among U.S. plastic surgeons, 4.2% held financial relationships with corporations and were likely to be paid more when consulting for small companies. CONCLUSIONS Consulting payments make up a large proportion of payments included in the Open Payments Database. Although sex, state, company type, and sole proprietorship did not correlate with higher pay, plastic surgeons who consulted for small companies were paid more per payment than those working for large companies. Future studies are warranted to determine whether these industry financial relationships impact physician behavior.
Collapse
Affiliation(s)
| | - Samuel R Boas
- From Case Western Reserve University School of Medicine
| | - Corinne Wee
- the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center
| | | | - Anand Kumar
- the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center
| |
Collapse
|
4
|
Betts C, Kakkilaya A, Vasireddy S, Arora N, Prasad V, Powell K. Financial conflicts of interest of physicians followed by oncology journals on Twitter. J Cancer Res Clin Oncol 2023; 149:14137-14144. [PMID: 37552310 DOI: 10.1007/s00432-023-05230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Physicians have increasingly adopted Twitter as a discussion and distribution platform for oncology research. While the influence of financial conflicts of interests (FCOI) on medical research is well documented, their role in the dissemination of research on social media platforms is not well known. In this study, we sought to evaluate the FCOIs of physicians followed by the top three oncology journals on Twitter. MATERIALS AND METHODS We used the Open Payments Search Tool ( https://openpaymentsdata.cms.gov ) to assess FCOIs between 2016 and 2021 of United States (US) physicians followed by three oncology journals (Journal of Clinical Oncology, The Lancet Oncology, and Annals of Oncology) on Twitter. RESULTS Of 1914 Twitter accounts followed by the top three oncology journals on Twitter, 547 (28.6%) belonged to US physicians. Of these, 463 (84.6%) received general payments between 2016 and 2021. After excluding 30 US physicians currently in residency or fellowship, this percentage increased to 88.2% (n = 456/517). Combined, the median (interquartile range) general payment amount was $8100 ($200-90,000). Additionally, over $42 million in general payments were made between 2016 and 2021. CONCLUSION Our findings offer insight on FCOIs between oncology journals and US physicians on Twitter. These findings may serve as the foundation for future research regarding optimal medical journal conduct on social media platforms.
Collapse
Affiliation(s)
- Colton Betts
- School of Medicine, Texas A&M Health Science Center, 8447 Riverside Pkwy, Bryan, TX, 77807, USA
| | - Akash Kakkilaya
- School of Medicine, Texas A&M Health Science Center, 8447 Riverside Pkwy, Bryan, TX, 77807, USA
| | - Satvik Vasireddy
- College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Drive, Henderson, NV, 89014, USA
| | - Neha Arora
- School of Medicine, Texas A&M Health Science Center, 8447 Riverside Pkwy, Bryan, TX, 77807, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA, 94158, USA
| | - Kerrington Powell
- School of Medicine, Texas A&M Health Science Center, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
| |
Collapse
|
5
|
Lee ZH, Diep GK, Brydges HT, Berman ZP, Alfonso AR, Ramly EP, Chaya BF, Thanik VD. Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery? Plast Reconstr Surg 2023; 152:376e-384e. [PMID: 36827475 DOI: 10.1097/prs.0000000000010320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND No study has assessed the impact of financial conflicts of interests (COIs) on the reporting of breast reconstruction outcomes with acellular dermal matrix (ADM) in peer-reviewed publications. The authors hypothesized that there is (1) an association between financial COIs and likelihood of studies reporting benefits in using ADM, and (2) inconsistent reporting of financial COIs. METHODS The PubMed database was used to identify articles that reported on the use of ADM in breast surgery in four leading plastic surgery journals from January of 2014 to December of 2019. Financial COIs for authors were determined using the open payments database. RESULTS Fifty-five articles were included. Twenty-four articles (43.6%) supported use of ADM, 12 (21.8%) did not promote ADM use, and 19 (34.5%) were neutral. Fifty-one studies (92.7%) had either a first or senior author with a COI, and authors with a COI more commonly reported positive outcomes ( P = 0.02). Studies with positive outcomes featured first authors who received significantly larger financial payments ($95,955 versus $15,642; P = 0.029) compared with studies with negative or neutral outcomes. Receiver operating characteristic curve demonstrated that studies with first authors receiving over $376.28 were more likely to report positive results. Eight senior authors and three first authors received greater than $500 from ADM producers yet did not report any financial disclosure. CONCLUSIONS Financial COI is associated with higher likelihood of studies reporting benefit of using ADM in breast surgery. There remains inconsistent reporting of COIs, and better oversight is needed to ensure unbiased publication on the use of ADM in breast surgery.
Collapse
Affiliation(s)
- Z-Hye Lee
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| |
Collapse
|
6
|
Spector CL, Hernandez J, Shatawi Z, Quintero LA, Rosenthal A, Parreco JP, Buicko JL. Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties. Am Surg 2023:31348231160834. [PMID: 36852997 DOI: 10.1177/00031348231160834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty. METHODS The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty. RESULTS There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656). DISCUSSION Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.
Collapse
Affiliation(s)
- Chelsea L Spector
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Jennifer Hernandez
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Luis A Quintero
- General Surgery Residency, 3933Memorial Healthcare System, Hollywood, FL, USA
| | - Andrew Rosenthal
- Trauma Critical Care Surgery, 1782Florida Atlantic University, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, 1782Florida Atlantic University, Hollywood, FL, USA
| | - Jessica L Buicko
- Endocrine, Breast, and General Surgery, 1782Florida Atlantic University, Boynton Beach, FL, USA
| |
Collapse
|
7
|
Powell K, McCall K, Hooda K, Prasad V, Kakkilaya A. Financial conflicts of interest of physicians followed by neurosurgical journals on Twitter. Int J Health Plann Manage 2023; 38:679-686. [PMID: 36597174 DOI: 10.1002/hpm.3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Social media, particularly Twitter, has played an increasing role in networking and the dissemination of neurosurgical research. Despite extensive study on financial conflicts of interest (FCOI) influencing medical research, little is known about the function of conflicts of interest on social media and the influence they may have. In this study, we sought to evaluate the FCOI of physicians followed on Twitter by the top three neurosurgical journals. MATERIALS AND METHODS We analysed the FCOI of United States (US) physicians followed by the top three neurosurgical journals (Journal of Neurosurgery, World Neurosurgery, Neurosurgery) on Twitter. We determined the FCOIs of each physician using the Open Payments Search Tool located at https://openpaymentsdata.cms.gov and summed the data between 2014 and 2021. RESULTS We examined 2651 Twitter accounts followed by the top three neurosurgical journals on Twitter and determined 705 (26.6%) belonged to US physicians. Of the 705 US physicians, 577 (81.8%) received general payments between 2014 and 2021. After excluding US physicians currently in residency or fellowship (n = 157), this percentage increased to 93.2% (n = 511/548). In total, nearly $70 million in general payments were made between 2014 and 2021. CONCLUSION These findings raise questions regarding the interaction between neurosurgical journals and the medical community on Twitter. This study may serve as the basis for future work on best practices for medical journals navigating their affiliations on Twitter.
Collapse
Affiliation(s)
- Kerrington Powell
- School of Medicine, Texas A&M Health Science Center, Bryan, Texas, USA
| | - Kyle McCall
- School of Medicine, Texas A&M Health Science Center, Bryan, Texas, USA
| | - Karan Hooda
- School of Medicine, Texas A&M Health Science Center, Bryan, Texas, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Akash Kakkilaya
- School of Medicine, Texas A&M Health Science Center, Bryan, Texas, USA
| |
Collapse
|
8
|
Powell K, Kakkilaya A, Haslam A, Prasad V. Financial Conflicts of Interest of OncoAlert: An Informal Oncology Professional Network. J Cancer Policy 2022; 34:100369. [DOI: 10.1016/j.jcpo.2022.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
|
9
|
Ozaki A, Murayama A, Harada K, Saito H, Sawano T, Tanimoto T, Ozieranski P. How Do Institutional Conflicts of Interest Between Pharmaceutical Companies and the Healthcare Sector Become Corrupt? A Case Study of Scholarship Donations Between Department of Clinical Anesthesiology, Mie University, and Ono Pharmaceutical in Japan. Front Public Health 2022; 9:762637. [PMID: 35047471 PMCID: PMC8761953 DOI: 10.3389/fpubh.2021.762637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Institutional conflicts of interest (ICOIs) with pharmaceutical companies can bias internal operation of healthcare organizations. Naturally, a scholarship donation—which is a donation scheme unique to Japan, provided to healthcare organizations and their subunits to encourage educational and academic activities related to the development of new drugs—fall into the ICOI category. While anecdotal evidence exists that scholarship donations have been used as bribes by pharmaceutical companies, there has been little case study research that would illuminate the workings of this “gray area” mechanism. From this perspective, we offer an in-depth analysis of a recent scandal involving the Department of Clinical Anesthesiology, Mie University and Ono Pharmaceutical, where a scholarship donation was used by a pharmaceutical company to increase the prescription of one of its key drugs at a hospital department. Available evidence also suggests that a professor based within the department originally requested a scholarship donation from the company, which became an initial trigger of the scandal. We argue that by scrutinizing scholarship donations we can gain insight into problems specific to ICOIs between the pharmaceutical companies and the healthcare sector in Japan. In addition, scholarship donations can be understood as a form of “gifts” which have been found to underpin certain forms of pharmaceutical companies' promotional activities in Japan but also in other countries. We conclude by highlighting potential institutional remedies, which may alleviate ICOIs and corrupt behavior affecting the healthcare sector.
Collapse
Affiliation(s)
- Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Kayo Harada
- Medical Governance Research Institute, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| |
Collapse
|
10
|
Torgerson T, Wayant C, Cosgrove L, Akl EA, Checketts J, Dal Re R, Gill J, Grover SC, Khan N, Khan R, Marušić A, McCoy MS, Mitchell A, Prasad V, Vassar M. Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform. BMJ Evid Based Med 2022; 27:46-54. [PMID: 33177167 DOI: 10.1136/bmjebm-2020-111503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
Abstract
Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.
Collapse
Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Lisa Cosgrove
- Department of Counseling Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jake Checketts
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Rafael Dal Re
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad, Autónoma de Madrid, Madrid, Spain
| | - Jennifer Gill
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nasim Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Matthew S McCoy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, Portland, Oregon, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
11
|
Pettit RW, Kaplan J, Delancy MM, Reece E, Winocour S, Offodile AC, Kumar A, Chu CK. Industry Payments to Plastic Surgeons: What Has Changed Over the Last 6 Years Following Implementation of the Physician Payments Sunshine Act? Aesthet Surg J 2022; 42:210-221. [PMID: 33780536 DOI: 10.1093/asj/sjab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Open Payments Program, as designated by the Physician Payments Sunshine Act, is the single largest repository of industry payments made to licensed physicians within the United States. Though sizeable in its dataset, the database and user interface are limited in their ability to permit expansive data interpretation and summarization. OBJECTIVES The authors sought to comprehensively compare industry payments made to plastic surgeons with payments made to all surgeons and all physicians to elucidate industry relationships since implementation. METHODS The Open Payments Database was queried between 2014 and 2019, and inclusion criteria were applied. These data were evaluated in aggregate and for yearly totals, payment type, and geographic distribution. RESULTS A total 61,000,728 unique payments totaling $11,815,248,549 were identified over the 6-year study period; 9089 plastic surgeons, 121,151 surgeons, and 796,260 total physicians received these payments. Plastic surgeons annually received significantly less payment than all surgeons (P = 0.0005). However, plastic surgeons did not receive significantly more payment than all physicians (P = 0.0840). Cash and cash equivalents proved to be the most common form of payment; stock and stock options were least commonly transferred. Plastic surgeons in Tennessee received the most in payments between 2014 and 2019 (mean $76,420.75). California had the greatest number of plastic surgeons who received payments (1452 surgeons). CONCLUSIONS Plastic surgeons received more in industry payments than the average of all physicians but received less than all surgeons. The most common payment was cash transactions. Over the past 6 years, geographic trends in industry payments have remained stable.
Collapse
Affiliation(s)
- Rowland W Pettit
- Baylor College of Medicine, Department of Medicine, Houston, TX, USA
| | - Jordan Kaplan
- Baylor College of Medicine, Department of Plastic Surgery, Houston, TX, USA
| | | | - Edward Reece
- Baylor College of Medicine, Division of Plastic Surgery, Houston, TX, USA
| | - Sebastian Winocour
- Baylor College of Medicine, Division of Plastic Surgery, Houston, TX, USA
| | - Anaeze C Offodile
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anand Kumar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Carrie K Chu
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
12
|
Inoue K, Figueroa JF, Kondo N, Tsugawa Y. Changes in industry marketing payments to physicians during the covid-19 pandemic: quasi experimental, difference-in-difference study. BMJ MEDICINE 2022; 1:e000219. [PMID: 36936580 PMCID: PMC9978761 DOI: 10.1136/bmjmed-2022-000219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
Objective To determine changes in industry marketing payments to physicians due to the covid-19 pandemic. Design Quasi experimental, difference-in-difference study. Data source US nationwide database of licensed physicians, the National Plan and Provider Enumeration System, which was linked to a database of industry marketing payments made to physicians, Open Payments. Population All licensed US physicians from 2018 to 2020 and those who received payments from industry. Main outcome measures Changes in the value and the number of monthly industry payments physician received before (January-February 2020) and during the pandemic (April-December 2020) were assessed, adjusting for physicians' characteristics (gender and specialty). As the control, data for the same months in 2019 were used. Industry payments by type of payments (eg, meals, travel, consulting fees, speaker compensation, honorariums), were also examined. Results Among 880 589 US physicians included in this study, 267 463 (30.4%) physicians received a total of 4 117 482 non-research payments with $626 million ($710 per physician; £610; €708) in 2020 (40-44% decrease from $1047m in 2018 and $1115m in 2019). Industry payments decreased significantly in the months of the covid-19 pandemic (adjusted change in the value of -48.4%; 95% confidence interval -50.6 to -46.2; P<0.001; and adjusted change in the number of -47.4%, 95% confidence interval -47.7 to -47.1; P<0.001), particularly for meals and travel fees. No evidence was seen of a decrease in the number of industry payments for consulting and honorariums. A similar pattern was observed across physicians' gender and specialty. Conclusions Industry payments to physicians, particularly those involving physical interactions such as meals and travel, substantially decreased during the pandemic. How such changes affect prescription practices and the quality of clinical practice in the long term should be investigated.
Collapse
Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Kyoto University, Kyoto, Japan
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University, Kyoto, Japan
- Department of Health and Social Behavior, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Tsugawa
- General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| |
Collapse
|
13
|
Rahman MW, Trivedi NU, Bach PB, Mitchell AP. Increasing Financial Payments From Industry to Medical Oncologists in the United States, 2014-2017. J Natl Compr Canc Netw 2021; 20:jnccn20125. [PMID: 34965511 PMCID: PMC9309756 DOI: 10.6004/jnccn.2021.7024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Personal payments from the pharmaceutical industry to US physicians are common and are associated with changes in physicians' clinical practice and interpretation of clinical trial results. We assessed temporal trends in industry payments to oncologists, with particular emphasis on payments to authors of oncology clinical practice guideline and on payments related to immunotherapy drugs. METHODS We included US physicians with active National Plan and Provider Enumeration System records and demographic data available in the Centers for Medicare & Medicaid Services Physician Compare system who had a specialty type of medical oncology or general internal medicine. Medical oncologists serving on NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Panels were identified manually. Industry payments, and the subset associated with PD-1/PD-L1 drugs, were identified in Open Payments, the federal repository of all transactions of financial value from industry to physicians and teaching hospitals, from 2014 to 2017. RESULTS There were 13,087 medical oncologists and 85,640 internists who received payments. The mean, annual, per-physician value of payments to oncologists increased from $3,811 in 2014 to $5,854 in 2017, and from $444 to $450 for internists; the median payment increased from $152 to $199 for oncologists and remained at $0 for internists. Oncologists who served on NCCN Guidelines Panels received a greater value in payments and experienced a greater relative increase: mean payments increased from $10,820 in 2014 to $18,977 in 2017, and median payments increased from $500 to $1,366. Among companies marketing PD-1/PD-L1 drugs, mean annual per-oncologist payments associated with PD-1/PD-L1 drugs increased from $28 to $773. Total per-oncologist payments from companies marketing PD-1/PD-L1 drugs experienced a 165% increase from 2014 to 2017, compared with a 31% increase among similar companies not marketing PD-1/PD-L1 drugs. CONCLUSIONS Pharmaceutical industry payments increased for US oncologists from 2014 to 2017 more than for general internists. The increase was greater among oncologists contributing to clinical practice guidelines and among pharmaceutical companies marketing PD-1/PD-L1 drugs. The increasing flow of money from industry to US oncologists supports ongoing concern regarding commercial interests in guideline development and clinical decision-making.
Collapse
Affiliation(s)
- Mohammed W Rahman
- 1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Niti U Trivedi
- 1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter B Bach
- 1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron P Mitchell
- 1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
14
|
Frane N, Partan MJ, White PB, Iturriaga C, Tarazi JM, Roy T, Bitterman AD. Orthopaedic Trauma Surgeons' Financial Relationships With Industry: An Analysis of the Sunshine Act Reporting of Physician Open Payments From 2014 to 2019. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202111000-00004. [PMID: 34762611 PMCID: PMC8585280 DOI: 10.5435/jaaosglobal-d-21-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Orthopaedic trauma surgeons have an intricate relationship with the medical device industry. In the past decade, legislation has created transparency of monetary exchanges between physicians and industry. In 2013, the Physician Payments Sunshine Act was passed and ultimately led to the creation of the Open Payments Database. The purpose of this study was to evaluate trends in industry payments to orthopaedic trauma surgeons. METHODS A retrospective review of the Centers for Medicare & Medicaid Services' Open Payments Database was conducted for general industry payments to orthopaedic trauma surgeons from 2014 to 2019. Total payments and subtype payments were analyzed for yearly trends. All payments were converted to 2019 US dollars to adjust for inflation. Descriptive statistics included analysis of payments, number of surgeons, types of payments, top contributing companies, and regional comparisons. Trends were assessed through the Jonckheere-Terpstra test. Statistical significance was defined at P < 0.05. RESULTS From 2014 to 2019, 45,312 individual payments were given to orthopaedic trauma surgeons (N = 3208) accounting for a total of $41,376,397.85 (USD), with a mean of $919.54 per payment. Increased trends were noted for median annual payments, number of payments, and number of surgeons receiving payments. Compared with 2014 ($460.91), median payments were increased by 90.9% in 2016 ($879.85), 102.6% in 2018 ($933.81), and 178.6% in 2019 ($1284.06). Payment subtypes that demonstrated increasing median payments included consulting fees (P = 0.028); education (P < 0.001); entertainment, food, and beverage (P < 0.001); and travel (P = 0.019). Decreases in median payments were seen in royalties (P = 0.044) and grant funding (P < 0.001). Regional comparisons demonstrated increasing trends in median payments in the midwest (P = 0.011), south (P < 0.001), and west (P = 0.003), but not in the northeast (P = 0.081). DISCUSSION In our study, we found that industry payments to orthopaedic trauma surgeons were increasing markedly between 2014 and 2019, particularly among consulting fees, education, entertainment, food and beverage, and travel.
Collapse
Affiliation(s)
- Nicholas Frane
- From the The Center for Orthopedic Research and Education (CORE) Institute, Orthopaedic Trauma Fellowship, Phoenix, AZ (Frane); the Northwell Health-Huntington Hospital, Department of Orthopaedic Surgery, Huntington, NY (Partan, White, Iturriaga, Tarazi, and Bitterman); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington, NY (Partan, White, Iturriaga, Tarazi, and Bitterman); and the Rowan University School of Osteopathic Medicine, Stratford, NJ (Roy)
| | | | | | | | | | | | | |
Collapse
|
15
|
Rhodes SC. Industry payments made to academic endodontists: Sex differences and other insights into financial relationships. J Am Dent Assoc 2021; 152:909-918. [PMID: 34482947 DOI: 10.1016/j.adaj.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Industry payments made to health care providers can create competing interests. The purpose of this study was to define the overall financial relationships between industry and academic endodontics faculty members, detail any variation in such payment data as related to individual faculty member characteristics and leadership position by institution type, and comment on the potential impacts from conflicts of interest (COIs) created by such relationships. METHODS The author identified and characterized academic endodontists from information on their institutional websites. The author obtained reported industry payments from 2013 through 2019 from the Centers for Medicare & Medicaid Services Open Payments database. The author also noted the distributions of academic endodontists and industry payments by institution, academic rank, sex, and residency program director position. The author subjected the data to descriptive and nonparametric analyses. RESULTS Of the 302 academic endodontists included, 240 (80%) accepted reported industry payments totaling $4,260,316.97. Overall, the median of total industry payments for all 302 faculty members was $217.89 (interquartile range [IQR], $34.06-$3,070.00). Among those accepting payments, the median amount was $382.80 (IQR, $110.40-$6,234.00). The top decile of paid academic endodontists received $3,669,291.47 in industry payments (86% of the total), with a median payment of $24,013 (IQR, $17,043-$91,190). Significant sex-associated industry payment differences were seen among the overall faculty and among those with the residency program director position. CONCLUSIONS Most academic endodontists accept industry payments. Significant sex differences exist in overall faculty member academic rank distribution, leadership role, and accepted median industry payment amounts. COI issues have the potential to arise among academic endodontists when such industry payments are accepted. PRACTICAL IMPLICATIONS Existing sex disparities in academic endodontics within the United States ideally should be acknowledged. COI issues can arise when academic faculty members accept industry payments. Public knowledge of these conflicts could negatively affect individual faculty members, their institutions, and related areas such as academic publishing. Appropriate faculty member COI disclosure, attestation, annual updates, and transparency are important mitigation measures.
Collapse
|
16
|
Goshtasbi K, Abouzari M, Abiri A, Ziai K, Lehrich BM, Risbud A, Bayginejad S, Lin HW, Djalilian HR. Trends and patterns of neurotology drug prescriptions on a nationwide insurance database. Laryngoscope Investig Otolaryngol 2021; 6:1096-1103. [PMID: 34667853 PMCID: PMC8513439 DOI: 10.1002/lio2.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/22/2021] [Accepted: 06/22/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To examine neurotologists' 2013 to 2016 Medicare Part-D data and evaluate commonly prescribed medications, longitudinal changes in prescribing patterns, presumed associated pathologies, and cost distribution across United States. METHODS Comprehensive prescription data of Part-D-participating neurotologists was quiered from the 2013 to 2016 Medicare Part-D database. Outcome variables consisted of the 25 most commonly prescribed + refilled medications, cost distribution per medication, presumed associated pathologies, and standardized prescription cost across United States. RESULTS Of the 594 available U.S. neurotologists, 336 (57%) were found in the Medicare Part-D database. In 2016, total prescription costs were $4 483 268 with an averaged $13 343 ± $18 698 per neurotologist. The three most frequently filled drugs were fluticasone propionate, ciprofloxacin, and triamterene-hydrochlorothiazide. From 2013 to 2016, the greatest change in prescription pattern was observed with azelastine (+188%), montelukast sodium (+104%), mupirocin (+63%), and mometasone (-91%), whereas the greatest change in relative drug cost distribution was seen in ofloxacin, (+695.7%) neomycin-polymyxin-hydrocortisone (+262.1%), and mometasone (-83%). Triamterene-hydrochlorothiazide, prednisone, montelukast, amoxicillin-clavulanate, azelastine, spironolactone, and mupirocin had statistically significant increases in average number of prescriptions per physician, whereas ofloxacin and mometasone had significant decreases. Medications presumably treating Eustachian tube dysfunction, Meniere's disease, and vestibular migraine had the greatest percent changes across years. Cost distribution of four drugs increased upwards of 100%. Geographic analysis demonstrated that Southern and Midwest regions had higher standardized prescription costs. CONCLUSIONS This study is the first to analyze neurotologists' trends in prescribing patterns, regional prescription cost distributions, and commonly treated pathologies. This can lead to better standardization of prescribing patterns and cost in the future.
Collapse
Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Kasra Ziai
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Brandon M. Lehrich
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Adwight Risbud
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Soha Bayginejad
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Harrison W. Lin
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Biomedical EngineeringUniversity of CaliforniaIrvineCaliforniaUSA
| |
Collapse
|
17
|
Mitchell AP, Mishra A, Dey P, Curry MA, Trivedi NU, Haddadin M, Rahman MW, Winn AN, Dusetzina SB, Bach PB. Personal Payments from Pharmaceutical Companies to Authors of Oncology Clinical Practice Guidelines. Oncologist 2021; 26:771-778. [PMID: 33982829 PMCID: PMC8417859 DOI: 10.1002/onco.13823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Oncologists who author clinical practice guidelines frequently have financial relationships with the pharmaceutical industry. It is unknown whether participation on clinical practice guideline committees is associated with differences in the amounts of industry money received. MATERIALS AND METHODS We conducted a nested case-control study from August 2013 to December 2018. We manually abstracted membership records of National Comprehensive Cancer Network (NCCN) Guidelines committees for the 20 most common cancers and linked to Open Payments. The study sample included medical oncologists selected to join an NCCN Guidelines committee ("joiners") during the study period. Joiners were matched 1:2 to medical oncologists who had no participation on NCCN committees (controls) by gender, NCCN institution, and medical school graduation year. We performed difference-in-differences (DiD) estimation to assess whether selection to an NCCN committee was associated with the dollar value of payments received from industry, using generalized estimating equations to address correlation between matched pairs and between repeated observations of the same pair. RESULTS During the study period, 54 physicians joined an NCCN Guidelines committee. These physicians received more payments than matched controls in the year prior to joining ($11,259 vs. $3,427; p = .02); this difference did not increase in the year after joining (DiD = $731; p = .45). CONCLUSION Medical oncologists selected to NCCN Guidelines committees had greater financial ties to industry than their peers. The potential influence of industry in oncology clinical practice guidelines may be reduced through the selection of committee members with fewer ties to industry. IMPLICATIONS FOR PRACTICE Oncologists who author clinical practice guidelines frequently have financial conflicts of interest with the pharmaceutical industry. This creates concern about the potential for industry influence on guidelines. However, it is unknown whether oncologists who author guidelines have greater industry relationships than their peers. This study compared medical oncologists who were newly selected to join a National Comprehensive Cancer Network (NCCN) Guidelines panel with medical oncologists at the same institutions and at similar career stages. At the time they joined, oncologists joining NCCN Guidelines panels had received more than three times the dollar value of industry payments than their peers. The potential for industry influence may be reduced by the selection of less-conflicted panel members.
Collapse
Affiliation(s)
- Aaron P. Mitchell
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Akriti Mishra
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Pranam Dey
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Michael A. Curry
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Niti U. Trivedi
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Michael Haddadin
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- University of Massachusetts Memorial Medical CenterWorcesterMassachusettsUSA
| | - Mohammed W. Rahman
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Hunter College, State University of New YorkNew YorkNew YorkUSA
| | - Aaron N. Winn
- Department of Clinical Sciences, School of Pharmacy, Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Stacie B. Dusetzina
- Department of Health Policy, School of Medicine, Vanderbilt UniversityNashvilleTennesseeUSA
| | - Peter B. Bach
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| |
Collapse
|
18
|
Metzger AL, Kusi Appiah A, Wright CM, Jairam V, Amini A, Park HS, Welsh JW, Thomas CR, Verma V, Ludmir EB. Financial relationships between industry and principal investigators of US cooperative group randomized cancer clinical trials. Int J Cancer 2021; 149:1683-1690. [PMID: 34173669 DOI: 10.1002/ijc.33719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Abstract
Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For our study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014 to 2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945, respectively, and $301 693 and $49 824 RF, respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < .05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < .001 GP, P = .008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential "industry bias" that could influence the integrity of their conclusions.
Collapse
Affiliation(s)
- April L Metzger
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher M Wright
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James W Welsh
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center @ Dartmouth University, Lebanon, New Hampshire, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
19
|
Partan MJ, White PB, Frane N, Iturriaga CR, Bitterman A. The Influence of the Sunshine Act on Industry Payments to United States Orthopaedic Sports Medicine Surgeons. Arthroscopy 2021; 37:1929-1936. [PMID: 33677022 DOI: 10.1016/j.arthro.2021.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the present study is to investigate trends in overall payments to orthopaedic sports medicine surgeons reported by the Open Payments Database (OPD) over the 6 full years of available data (2014-2019). METHODS A retrospective review of industry payments to United States sports medicine trained orthopaedic surgeons from 2014 to 2019 was performed using the Centers for Medicare and Medicaid Services OPD. Total payments and subtype payments were analyzed for yearly trends. Regional analysis was also performed. The primary outcome was the overall trend in total median payments (defined as the median total payments per surgeon per year), which was assessed via the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P values < .05 were considered statistically significant. RESULTS From 2014 to 2019, there were a total of 1,941,772 payments to 12,816 sports medicine orthopaedic surgeons. The median payments to surgeons demonstrated a significant upward trend (P < .001). The total number of payments (r = 0.002; P = .99) did not significantly correlate with changing year. The top 5 compensated surgeons received 45.8% of all industry contributions with a median total payment of $9,210,974.06 (interquartile range: 25,029,951.46). The majority of industry contributions in the top 5 earners were attributed to royalties and licenses (98.7%). Across the study period, 89.4% of the total orthopaedic sports medicine surgeons received a yearly total payment less than $10,000, which made up 8.3% of the total industry payment sum. Those receiving a yearly total payment greater than $500,000 accounted for 0.3% of surgeons but received 53.4% of the sum payments. We found a yearly increasing trend in payments in all regions including the Midwest, South, Northeast, and West (P < .001, P < .001, P < .001, and P = .006). CONCLUSION Despite the transparency of reporting mandated by the Sunshine Act, orthopaedic sports medicine surgeons have continued to maintain industry relationships with a notable disparity in distribution. CLINICAL SIGNIFICANCE Our analysis suggests continued relationships among sports medicine surgeons and industry. Future research is needed to determine how this impacts medical practice in the United States.
Collapse
Affiliation(s)
- Matthew J Partan
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A..
| | - Peter B White
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Nicholas Frane
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Cesar R Iturriaga
- Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Adam Bitterman
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| |
Collapse
|
20
|
Association between industry payments and prescriptions of long-acting insulin: An observational study with propensity score matching. PLoS Med 2021; 18:e1003645. [PMID: 34061852 PMCID: PMC8205129 DOI: 10.1371/journal.pmed.1003645] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 06/15/2021] [Accepted: 05/04/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The rapidly increased spending on insulin is a major public health issue in the United States. Industry marketing might be one of the upstream determinants of physicians' prescription of long-acting insulin-the most commonly used and costly type of insulin, but the evidence is lacking. We therefore aimed to investigate the association between industry payments to physicians and subsequent prescriptions of long-acting insulin. METHODS AND FINDINGS Using the databases of Open Payments and Medicare Part D, we examined the association between the receipt of industry payments for long-acting insulin in 2016 and (1) the number of claims; (2) the costs paid for all claims; and (3) the costs per claim of long-acting insulin in 2017. We also examined the association between the receipt of payments and the change in these outcomes from 2016 to 2017. We employed propensity score matching to adjust for the physician-level characteristics (sex, years in practice, specialty, and medical school attended). Among 145,587 eligible physicians treating Medicare beneficiaries, 51,851 physicians received industry payments for long-acting insulin worth $22.3 million. In the propensity score-matched analysis including 102,590 physicians, we found that physicians who received the payments prescribed a higher number of claims (adjusted difference, 57.8; 95% CI, 55.8 to 59.7), higher costs for total claims (adjusted difference, +$22,111; 95% CI, $21,387 to $22,836), and higher costs per claim (adjusted difference, +$71.1; 95% CI, $69.0 to $73.2) of long-acting insulin, compared with physicians who did not receive the payments. The association was also found for changes in these outcomes from 2016 to 2017. Limitations to our study include limited generalizability, confounding, and possible reverse causation. CONCLUSIONS Industry marketing payments to physicians for long-acting insulin were associated with the physicians' prescriptions and costs of long-acting insulin in the subsequent year. Future research is needed to assess whether policy interventions on physician-industry financial relationships will help to ensure appropriate prescriptions and limit overall costs of this essential drug for diabetes care.
Collapse
|
21
|
Inoue K, Figueroa JF, DeJong C, Tsugawa Y, Orav EJ, Shen C, Kazi DS. Association Between Industry Marketing Payments and Prescriptions for PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitors in the United States. Circ Cardiovasc Qual Outcomes 2021; 14:e007521. [PMID: 33966446 DOI: 10.1161/circoutcomes.120.007521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Marketing payments from the pharmaceutical industry to physicians have come under scrutiny due to their potential to influence clinical decision-making. Two proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were approved by the US Food and Drug Administration in 2015 for reducing low-density lipoprotein cholesterol in high-risk patients, but their initial uptake was limited due to their high-cost and stringent prior authorization requirements. We sought to investigate the association between industry marketing and early adoption of PCSK9i among US physicians. METHODS We used nationwide databases of primary care physicians, cardiologists, and endocrinologists treating Medicare beneficiaries to examine the association between PCSK9i-related marketing payments in 2016 and the number of filled PCSK9i prescriptions in 2017, after adjusting for physician characteristics. In subgroup analyses, we stratified our analyses by physician specialty and prior experience with prescribing PCSK9i. RESULTS Among 209 840 physicians included in this analysis, 49 341 (24%) physicians received 292 941 PCSK9i-related marketing payments in 2016. The total value of these payments was $19 million, with a median payment of $61 per physician (interquartile range, $25-$132). Most payments (95%) were for meals, with a median of $14 per meal. The receipt of PCSK9i-related payments in 2016 was associated with increased PCSK9i prescription in 2017 (adjusted risk ratio, 3.18 [95% CI, 2.95-3.42]). This association was larger among primary care physicians (adjusted risk ratio, 6.67 [95% CI, 5.87-7.57]) than cardiologists (adjusted risk ratio, 2.00 [95% CI, 1.84-2.16]) and endocrinologists (adjusted risk ratio, 4.06 [95% CI, 2.95-5.59]). The association was observed across all types of payments. CONCLUSIONS At a time when few physicians had experience with prescribing PCSK9i under strict prior authorization requirements, industry marketing payments to physicians for PCSK9i, predominantly in the form of meals, were associated with increased PCSK9i prescription in the subsequent year.
Collapse
Affiliation(s)
- Kosuke Inoue
- Department of Epidemiology (K.I.) UCLA Fielding School of Public Health.,Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan (K.I.)
| | - Jose F Figueroa
- Department of Health Policy and Management (J.F.F., E.J.O.) Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.F.F.)
| | - Colette DeJong
- Department of Medicine, University of California, San Francisco School of Medicine (C.D.)
| | - Yusuke Tsugawa
- Department of Health Policy and Management (Y.T.), UCLA Fielding School of Public Health.,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (Y.T.)
| | - E John Orav
- Department of Health Policy and Management (J.F.F., E.J.O.) Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Biostatistics (E.J.O.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.S., D.S.K.).,Harvard Medical School, Boston, MA (C.S., D.S.K.)
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.S., D.S.K.)
| |
Collapse
|
22
|
Review of Industry Payments to General Orthopaedic Surgeons Reported by the Open Payments Database: 2014 to 2019. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e21.00060. [PMID: 33974570 PMCID: PMC8116034 DOI: 10.5435/jaaosglobal-d-21-00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Introduction: The Physician Payments Sunshine Act was placed into law in 2010 in an effort to create transparency between physicians and industry. Along with many other specialties, orthopaedic surgeons have long worked intimately with medical industry companies. This study aimed to evaluate trends in industry payments to general orthopaedic surgeons from 2014 to 2019. Methods: A retrospective review of the Center of Medicare and Medicaid Services' Open Payments Database was done to identify all industry payments to all general orthopaedic surgeons (ie, not subspecialty affiliated) from 2014 to 2019. The researchers analyzed total payments and subtype payments for yearly trends, and a regional analysis was done. The primary outcome was the overall trend in total median payments, which was assessed through the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P < 0.05 was considered statistically significant. Results: Between 2014 and 2019, a total of 1,330,543 payments totaling $1.79 billion dollars was paid to 108,041 general orthopaedic surgeons. During this time, the number of surgeons receiving payments increased with a significant uptrend in median payments per surgeon (P < 0.001; Table 1). The top 25% percentile of general orthopaedic surgeons received >95% of payments, whereas the bottom 25% received <0.1%. The general payment types all saw significant increases (P < 0.001) between 2014 and 2019, with the exception of “Ownership or Investment Interests” (P = 0.657) and “Royalty or License” (P = 0.517). Significant regional uptrends in median industry payments were also seen in the Midwest, Northeast, South, and West (P < 0.001). Four of the top five orthopaedic industry companies made payment increases between 2014 and 2019. Conclusion: Industry payments to general orthopaedic surgeons between 2014 and 2019 have increased with a considerable disparity in payments among the top-paid orthopaedic surgeons.
Collapse
|
23
|
Roberts‐Thomson IC. Ethics, gastroenterologists, and pharmaceutical and equipment companies. JGH Open 2020; 4:1025-1026. [PMID: 33319032 PMCID: PMC7731820 DOI: 10.1002/jgh3.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ian C Roberts‐Thomson
- Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
24
|
Motiwala M, Herr MJ, Jampana Raju SS, Lillard J, Ajmera S, Saad H, Schultz A, Fraser B, Wallace D, Norrdahl S, Akinduro O, Oravec CS, Xu R, Jimenez B, Justo M, Hardee J, Vaughn BN, Michael LM, Klimo P. Dissecting the Financial Relationship Between Industry and Academic Neurosurgery. Neurosurgery 2020; 87:1111-1118. [PMID: 32779708 DOI: 10.1093/neuros/nyaa257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Established by the Centers for Medicare and Medicaid Services (CMS), the Open Payments Database (OPD) has reported industry payments to physicians since August 2013. OBJECTIVE To evaluate the frequency, type, and value of payments received by academic neurosurgeons in the United States over a 5-yr period (2014-2018). METHODS The OPD was queried for attending neurosurgeons from all neurosurgical training programs in the United States (n = 116). Information from the OPD was analyzed for the entire cohort as well as for comparative subgroup analyses, such as career stage, subspecialty, and geographic location. RESULTS Of all identified neurosurgeons, 1509 (95.0%) received some payment from industry between 2014 and 2018 for a total of 106 171 payments totaling $266 407 458.33. A bimodal distribution was observed for payment number and total value: 0 to 9 (n = 438) vs > 50 (n = 563) and 0-$1000 (n = 418) vs >$10 000 (n = 653), respectively. Royalty/License was the most common type of payment overall (59.6%; $158 723 550.57). The median number (40) and value ($8958.95) of payments were highest for mid-career surgeons. The South-Central region received the most money ($117 970 036.39) while New England received the greatest number of payments (29 423). Spine surgeons had the greatest median number (60) and dollar value ($20 551.27) of payments, while pediatric neurosurgeons received the least (8; $1108.29). Male neurosurgeons received a greater number (31) and value ($6395.80) of payments than their female counterparts (11, $1643.72). CONCLUSION From 2014 to 2018, payments to academic neurosurgeons have increased in number and value. Dollars received were dependent on geography, career stage, subspecialty and gender.
Collapse
Affiliation(s)
- Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael J Herr
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jock Lillard
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Andrew Schultz
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brittany Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sebastian Norrdahl
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olutomi Akinduro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Chesney S Oravec
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Raymond Xu
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brian Jimenez
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Melissa Justo
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennings Hardee
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brandy N Vaughn
- Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| |
Collapse
|
25
|
Annapureddy AR, Henien S, Wang Y, Minges KE, Ross JS, Spatz ES, Desai NR, Peterson PN, Masoudi FA, Curtis JP. Association Between Industry Payments to Physicians and Device Selection in ICD Implantation. JAMA 2020; 324:1755-1764. [PMID: 33141208 PMCID: PMC7610190 DOI: 10.1001/jama.2020.17436] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Little is known about the association between industry payments and medical device selection. OBJECTIVE To examine the association between payments from device manufacturers to physicians and device selection for patients undergoing first-time implantation of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D). DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, patients who received a first-time ICD or CRT-D device from any of the 4 major manufacturers (January 1, 2016-December 31, 2018) were identified. The data from the National Cardiovascular Data Registry ICD Registry was linked with the Open Payments Program's payment data. Patients were categorized into 4 groups (A, B, C, and D) corresponding to the manufacturer from which the physician who performed the implantation received the largest payment. For each patient group, the proportion of patients who received a device from the manufacturer that provided the largest payment to the physician who performed implantation was determined. Within each group, the absolute difference in proportional use of devices between the manufacturer that made the highest payment and the proportion of devices from the same manufacturer in the entire study cohort (expected prevalence) was calculated. EXPOSURES Manufacturers' payments to physicians who performed an ICD or CRT-D implantation. MAIN OUTCOMES AND MEASURES The primary outcome of the study was the manufacturer of the device used for the implantation. RESULTS Over a 3-year period, 145 900 patients (median age, 65 years; 29.6% women) received ICD or CRT-D devices from the 4 manufacturers implanted by 4435 physicians at 1763 facilities. Among these physicians, 4152 (94%) received payments from device manufacturers ranging from $2 to $323 559 with a median payment of $1211 (interquartile range, $390-$3702). Between 38.5% and 54.7% of patients received devices from the manufacturers that had provided physicians with the largest payments. Patients were substantially more likely to receive devices made by the manufacturer that provided the largest payment to the physician who performed implantation than they were from each other individual manufacturer. The absolute differences in proportional use from the expected prevalence were 22.4% (95% CI, 21.9%-22.9%) for manufacturer A; 14.5% (95% CI, 14.0%-15.0%) for manufacturer B; 18.8% (95% CI, 18.2%-19.4%) for manufacturer C; and 30.6% (95% CI, 30.0%-31.2%) for manufacturer D. CONCLUSIONS AND RELEVANCE In this cross-sectional study, a large proportion of ICD or CRT-D implantations were performed by physicians who received payments from device manufacturers. Patients were more likely to receive ICD or CRT-D devices from the manufacturer that provided the highest total payment to the physician who performed an ICD or CRT-D implantation than each other manufacturer individually.
Collapse
Affiliation(s)
- Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shady Henien
- Section of Cardiovascular Medicine, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Erica S. Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nihar R. Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Pamela N. Peterson
- Department of Medicine, Denver Health Medical Center, Denver, Colorado
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
26
|
Dandu V, Siddamreddy S, Thombre V, Veerapaneni KD, Yadala S, Sheng S, Mahashabde R, Harada Y, Kapoor N, Onteddu S, Nalleballe K. A Five-Year Analysis of Industry Payments to Sleep Neurologists From 2014 Through 2018. Cureus 2020; 12:e10597. [PMID: 33110732 PMCID: PMC7581217 DOI: 10.7759/cureus.10597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Sleep medicine has been one of the fastest-growing medical fields in recent years. The industry plays a big role in developing new medications and devices for both diagnosis and treatment of sleep-related problems. We analyzed payments made by industry to physicians from 2014 through 2018 based on the Open Payments Program data. Methods Centers for Medicare and Medicaid Services Open Payment Program and American Board of Psychiatry and Neurology databases were explored to elicit financial relationships between industry and sleep neurologists. Results Payments made by industry to sleep neurologists have been steadily increasing from 2014 through 2018. Approximately 16% to 22% of sleep certified neurologists received payments from industry during the study period. Interestingly, the payments made to the top 10% of the sleep physicians contributed approximately 85% to 96% of the total payments. The top two categories to which the highest payments were made were compensation for services and royalty and/or licensing fees. Silenor® (doxepin), Xyrem® (sodium oxybate), Aptiom® (eslicarbazepine acetate), Belsomra® (suvorexant), and Fycompa® (perampanel) were most of the drugs, which made the highest payments, that got approved by the Food and Drug Administration in the last decade. Conclusions It seems that the industry is spending significant amounts of money in educating the physicians and in marketing the newer drugs. This analysis of the data on payments from industry is very useful in identifying any potential conflicts of interest from physicians. Further analyses are needed to study the trends of physician practice behavior and decision making.
Collapse
Affiliation(s)
- Vasuki Dandu
- Neurology, Baptist Health Medical Center, Little Rock, USA
| | | | - Vaishali Thombre
- Biostatistics and Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - Sisira Yadala
- Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sen Sheng
- Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Ruchira Mahashabde
- Biostatistics and Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Yohei Harada
- Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Nidhi Kapoor
- Neurology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Sanjeeva Onteddu
- Neurology/Stroke, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Krishna Nalleballe
- Neurology/Stroke, University of Arkansas for Medical Sciences, Little Rock, USA
| |
Collapse
|
27
|
Stoll M, Hubenschmid L, Koch C, Lieb K. Voluntary disclosures of payments from pharmaceutical companies to healthcare professionals in Germany: a descriptive study of disclosures in 2015 and 2016. BMJ Open 2020; 10:e037395. [PMID: 32948560 PMCID: PMC7500304 DOI: 10.1136/bmjopen-2020-037395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To analyse voluntary payment reports of pharmaceutical companies to German healthcare professionals (HCPs) in 2015 and 2016 based on an industry-self-regulating transparency codex. DESIGN AND PARTICIPANTS Cohort study of all German HCPs who voluntarily agreed that at least one payment they received in 2015 and 2016 from pharmaceutical companies is disclosed. MAIN OUTCOME MEASURES Number of HCPs who disclosed at least one payment in the database; separated by year of disclosure and whether they disclosed once or repeatedly. Amount of disclosed payments and distribution parameters of disclosed annual payment sums per person; separated by year of disclosure und whether they disclosed once or repeatedly. RESULTS 28 230 HCPs agreed to the disclosure of at least one payment in the database. In 2015, 19 905 HCPs agreed to the disclosure, decreasing to 15 782 HCPs in 2016. Whereas 7457 disclosed payments in both years, 12 448 disclosed only in 2015 and 8325 only in 2016. Payments of €32 426 721 in 2015 and €23 289 343 in 2016 were disclosed, that is, 27% and 23% of the total amounts spent on HCPs, respectively. Distribution of annual payments was skewed: the top 1% of HCPs disclosed annual payment sums between €17 049 and €200 194, while the median disclosed annual payment sum per person was €536 (IQR €1092). Disclosed payments were higher in male physicians and in physicians with higher academic degree. CONCLUSIONS If voluntary, disclosure rates of payments are low and therefore only provide a fragmented picture of interactions between HCPs and pharmaceutical companies. Efforts must be intensified to ensure obligatory disclosure of all payments worldwide.
Collapse
Affiliation(s)
- Marlene Stoll
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research (LIR) gGmbH, Mainz, Germany
| | - Lara Hubenschmid
- Leibniz Institute for Resilience Research (LIR) gGmbH, Mainz, Germany
| | - Cora Koch
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research (LIR) gGmbH, Mainz, Germany
| |
Collapse
|
28
|
Cambridge CL, Gatof ES, Weiss GJ, Davis RB. Financial Conflicts of Interest Change After a High-Impact Clinical Trial Publication in Oncology. J Patient Cent Res Rev 2020; 7:249-254. [PMID: 32760756 DOI: 10.17294/2330-0698.1735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Because financial conflicts of interest (FCOIs) may potentially influence patient care, hospital drug formularies, and treatment guidelines, it is important that these are disclosed. The purpose of this observational study was to quantify the changes in FCOI among U.S.-based academic authors in industry-sponsored oncology trials after a high-impact publication. Methods A list of all U.S.-based academic authors (authors) of industry-sponsored solid tumor clinical trials published between August 1, 2014, and December 31, 2015, in 6 high-impact journals (New England Journal of Medicine, Nature, Science, Lancet Oncology, Journal of Clinical Oncology, and Cancer Discovery) was assembled. Studies were limited to solid tumor oncology trials. After all authors were identified, direct and research funding was tabulated from CMS Open Payments for the year prior (Ypre) and the first 3 years following publication (Y1, Y2, Y3) in the high-impact journal. Summary statistics were tabulated and repeated-measures linear mixed-effects regression models were fit to examine changes after publication. Results A total of 102 publications with a total of 620 authors were identified. No FCOI was declared by 11, 12, 21, and 24 authors in Ypre, Y1, Y2, and Y3, respectively. In Ypre, Y1, Y2, and Y3: median FCOI for direct payments was $16,702 (range: $0-$3,180,356), $20,830 (range: $0-$3,180,356), $22,031 (range: $0-$920,746), and $21,356 (range: $0-$920,707), respectively; while median research funding was $559,202 (range: $0-$19,973,818), $505,031 (range $0-$19,920,452), $502,726 (range: $0-$15,729,776), and $497,342 (range: $0-$43,036,716), respectively. There were nonsignificant increases in total direct payments and total direct payments received from the sponsor (P>0.0125 for both) and statistically significant decreases in total associated research funding and total research funding from the research sponsor in Y1, Y2, and Y3 as compared to Ypre (P<0.0001 for both). Conclusions After publication of an industry-sponsored solid tumor clinical trial in a high-impact journal, authors had statistically significant decreases in research funding FCOI in the first 3 years postpublication compared to the year prior.
Collapse
Affiliation(s)
- Craig L Cambridge
- Facultad de Medicina, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Emily Stern Gatof
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Glen J Weiss
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Roger B Davis
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Ozaki A, Saito H, Senoo Y, Sawano T, Shimada Y, Kobashi Y, Yamamoto K, Suzuki Y, Tanimoto T. Overview and transparency of non-research payments to healthcare organizations and healthcare professionals from pharmaceutical companies in Japan: Analysis of payment data in 2016. Health Policy 2020; 124:727-735. [DOI: 10.1016/j.healthpol.2020.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
|
30
|
Katz MS, Anderson PF, Thompson MA, Salmi L, Freeman-Daily J, Utengen A, Dizon DS, Blotner C, Cooke DT, Sparacio D, Staley AC, Fisch MJ, Young C, Attai DJ. Organizing Online Health Content: Developing Hashtag Collections for Healthier Internet-Based People and Communities. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31251658 DOI: 10.1200/cci.18.00124] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twitter use has increased among patients with cancer, advocates, and oncology professionals. Hashtags, a form of metadata, can be used to share content, organize health information, and create virtual communities of interest. Cancer-specific hashtags modeled on a breast cancer community, #bcsm, led to the development of a structured set of hashtags called the cancer tag ontology. In this article, we review how these hashtags have worked with the aim of describing our experience from 2011 to 2017. We discuss useful guidelines for the development and maintenance of health-oriented communities on Twitter, including possible challenges to community sustainability and opportunities for future improvement and research.
Collapse
Affiliation(s)
| | | | | | - Liz Salmi
- Beth Israel Deaconess Medical Center, Boston, MA.,Brain Cancer Quality of Life Collaborative, Sacramento, CA
| | | | | | | | | | - David T Cooke
- University of California Davis Medical Center, Sacramento, CA
| | | | | | | | | | | |
Collapse
|
31
|
Cheng T, Boelitz K, Rybin D, Menard MT, Kalish J, Siracuse JJ, Farber A, Jones DW. Nationwide patterns in industry payments to academic vascular surgeons. J Vasc Surg 2020; 73:675-681. [PMID: 32535153 DOI: 10.1016/j.jvs.2020.04.527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Financial relationships between vascular surgeons and industry are essential to the development and adoption of innovative technology. However, these relationships may establish competing interests. Our objective was to describe publicly available financial transactions between industry and academic vascular surgeons. METHODS Academic vascular surgeons were identified and characterized on the basis of publicly available data correlated with Accreditation Council for Graduate Medical Education and Association of American Medical Colleges data to identify academic practice settings. Vascular surgeons were linked to Open Payments data for 2017 as reported by the Centers for Medicare & Medicaid Services. Univariate and nonparametric tests were used for analysis. RESULTS Of 1158 academic vascular surgeons identified, 997 (86%) received industry payments totaling $8,548,034. Overall, the median of total payments received was $814 (interquartile range [IQR], $124-$2863). The top paid decile of vascular surgeons received $29,645 (IQR, $16,128-$61,701). Payments to the top decile accounted for 81% of all payments. Payments did not vary by academic rank but did vary by sex, with male vascular surgeons (n = 954) receiving $889 (IQR, $146-$3217) vs female vascular surgeons (n = 204) receiving $467 (IQR, $87-$1533; P = .002). By leadership role, division chiefs received the highest median payment amount ($1571; IQR, $368-$11,281) compared with department chairs ($424; IQR, $56-$2698) and vascular surgeons without leadership role ($769; IQR, $117-$2592; P = .002). Differences in payments were also seen on the basis of U.S. census region: Northeast, $571 (IQR, $90-2462); Midwest, $590 (IQR, $75-$2364); South, $1085 (IQR, $241-$3405); and West, $1044 (IQR, $161-$4887; P = .001). The most common categories of payments were food and beverage (paid to 85% of all vascular surgeons), travel and lodging (35%), and consulting fees (13%). Among the top decile of vascular surgeons, median payments exceeded $10,000 for three categories: consulting fees, compensation, and honoraria. Payments were made by 178 distinct entities with median total payments of $286 (IQR, $70-$6285). The three top entities paid a total of $5,004,061, which accounted for 59% of all payments. Payments from at least one of the top three entities reached 76% of vascular surgeons. CONCLUSIONS Most academic vascular surgeons receive publicly reported industry payments that are paid by a limited number of entities, typically for food and beverage or travel and lodging. The top 10% of vascular surgeons received higher median payment amounts, totaling 81% of all industry payments. Vascular surgeons should be aware of publicly reported payment information and the potential for conflicts of interest.
Collapse
Affiliation(s)
- Thomas Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Kris Boelitz
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Jeffrey Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Mass.
| |
Collapse
|
32
|
Wiersma M, Kerridge I, Lipworth W. Status, Respect, and Stigma: A Qualitative Study of Non-financial Interests in Medicine. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:203-216. [PMID: 32162158 DOI: 10.1007/s11673-020-09970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
Conflicts of interest (COI) in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that this group of medical professionals saw non-financial interests-most notably the pursuit of status and respect and the avoidance of stigma-as potentially conflicting with other important interests (such as patient care).
Collapse
Affiliation(s)
- Miriam Wiersma
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ian Kerridge
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Wendy Lipworth
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
33
|
Inoue K, Figueroa JF, Orav EJ, Tsugawa Y. Association between industry payments for opioid products and physicians' prescription of opioids: observational study with propensity-score matching. J Epidemiol Community Health 2020; 74:647-654. [PMID: 32350126 DOI: 10.1136/jech-2020-214021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Industry marketing to physicians for opioids has received substantial attention as it can potentially influence physicians' prescription of opioids. However, robust evidence demonstrating a causal link between industry payments for opioids and physicians' prescription practice for opioids is lacking. METHODS Using the national databases of physicians treating Medicare beneficiaries, we examined the association between physicians' receipt of opioid-related industry payments in 2016 and (1) the number of opioids prescribed and (2) the annual expenditures for the opioid products by those physicians in 2017, using propensity-score matching in a 1:1 ratio adjusting for the physician characteristics (sex, years in practice, medical school attended, specialty), the number of opioid prescriptions in 2016, and physicians' financial relationships with industry in 2015. We compared matched pairs of physicians using the estimated effect and paired t-test. RESULTS Among 43 778 physicians included after propensity-score matching, physicians who received opioid-related industry payments in 2016 prescribed more opioids (153.8 vs 129.7; adjusted difference (95% CI), 24.1 (19.1 to 29.1)) and accounted for more spending due to opioids ($10 476 vs $6983; adjusted difference (95% CI), $3493 (2854 to 4134)) in 2017, compared with physicians who did not receive payments. The association was larger among primary care physicians than surgeons or specialists. The dose-response analysis revealed that even a small amount of industry payments was sufficient to effectively affect physicians' prescription practice of opioids. CONCLUSIONS Opioid-related industry payments to physicians in the prior year were associated with a higher number of opioid prescriptions and expenditures for opioid products in the subsequent year.
Collapse
Affiliation(s)
- Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Jose F Figueroa
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA .,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
| |
Collapse
|
34
|
Garrett-Mayer E, Kaltenbaugh MW, Spence R, Bruinooge SS, Hudis CA, Michels D, Schilsky RL. Discrepancies in Financial Self-Disclosures and Open Payments Reporting Among Authors of Clinical Oncology Research Studies. J Clin Oncol 2020; 38:480-487. [PMID: 31815584 DOI: 10.1200/jco.19.02467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Company-reported payments from the Open Payments database (OP) have been compared with self-disclosed financial relationships made by physician authors. Discrepancies have been viewed as under-reporting of financial relationships. Our goal was to perform a systematic comparison to determine sources of discordance between company-reported and self-reported financial relationships. METHODS Financial disclosures reported by 163 authors and presenters who published in Journal of Clinical Oncology or who presented an abstract at the ASCO 2018 Annual Meeting were obtained and matched to payment data in OP. Categories included ownership, research, consulting/services, honoraria, expenses, royalty/patent/intellectual property, and other disclosures. Measures of concordance and discordance were calculated on the basis of matches on both company and category of disclosure and matches on company. Results are reported overall and within certain categories of disclosures. RESULTS Overall concordance between disclosures to ASCO and payments in OP was 16% for company and category matching and 24% for matching on the basis of company only. Authors tended to report more disclosures for research and consulting to ASCO than appear in OP. Expense disclosures were more frequently reported in OP than to ASCO. No payments were categorized as ownership in OP, but 35 authors/presenters disclosed ownership (including stock) to ASCO. CONCLUSION Our results reveal substantial discordance between self-reported and company-reported financial relationships for authors who report clinical oncology research. These findings support the calls for development of standardized disclosure policies across medicine.
Collapse
Affiliation(s)
| | | | | | | | | | - Dina Michels
- American Society of Clinical Oncology, Alexandria, VA
| | | |
Collapse
|
35
|
Inoue K, Blumenthal DM, Elashoff D, Tsugawa Y. Association between physician characteristics and payments from industry in 2015-2017: observational study. BMJ Open 2019; 9:e031010. [PMID: 31542759 PMCID: PMC6756347 DOI: 10.1136/bmjopen-2019-031010] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the association between physician characteristics and the value of industry payments. DESIGN Observational study. SETTING AND PARTICIPANTS Using the 2015-2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution). MAIN OUTCOME MEASURES Our primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately. RESULTS Of 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015-2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21-30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians. CONCLUSIONS Industry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments.
Collapse
Affiliation(s)
- Kosuke Inoue
- Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Daniel M Blumenthal
- Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Devoted Health, Waltham, Massachusetts, USA
| | - David Elashoff
- Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Medicine Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Yusuke Tsugawa
- General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Policy Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
36
|
Ozaki A, Saito H, Onoue Y, Sawano T, Shimada Y, Somekawa Y, Tsuji A, Tanimoto T. Pharmaceutical payments to certified oncology specialists in Japan in 2016: a retrospective observational cross-sectional analysis. BMJ Open 2019; 9:e028805. [PMID: 31494604 PMCID: PMC6731803 DOI: 10.1136/bmjopen-2018-028805] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study investigated payments made by pharmaceutical companies to oncology specialists in Japan, what the payments were for and whether the receipt of such payments contravened any conflict of interest (COI) regulations. DESIGN, SETTING AND PARTICIPANTS Payment data to physicians, as reported by all pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association, were retrospectively extracted for 2016. Of the named individual recipients of payments, all certified oncologists were identified, using certification data from the Japanese Society of Medical Oncology (JSMO). The individual specialisations of each of the oncologists was also identified. OUTCOME Payments to individual cancer specialists and what they were for were identified. Factors associated with receipt of higher value payments and payment flows to specialties were determined. Companies selling oncology drugs with annual sales of ≥5 billion yen (£33.9 million, €40.2 million and $46.0 million) (high revenue-generating drugs) were identified. RESULTS In total, 59 companies made at least one payment to oncologists. Of the 1080 oncology specialists identified, 763 (70.6%) received at least one payment, while 317 received no payment. Of the 763, some 142 (13.1%) receiving at least 1 million yen (£6,800, €8,000 and $9200) accounted for 71.5% of the total. After adjustment of covariates, working for university hospitals and cancer hospitals and male gender were key factors associated with larger monetary payments. Payments preferentially targeted on cancer specialties using high revenue-generating drugs. The JSMO has its own COI policy for its members, but the policy did not mention any specific guidelines for certified oncology specialists. CONCLUSION Financial relationships were identified and quantified between pharmaceutical companies and oncology specialists, but the extent and worth varied significantly. Given the frequency and amounts of money involved in such linkages, it would be beneficial for specific COI regulations to be developed and policed for oncologists.
Collapse
Affiliation(s)
- Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Yosuke Onoue
- College of Humanities and Sciences, Nihon University, Tokyo, Japan
| | - Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | | | | | | |
Collapse
|
37
|
Ozieranski P, Csanadi M, Rickard E, Tchilingirian J, Mulinari S. Analysis of Pharmaceutical Industry Payments to UK Health Care Organizations in 2015. JAMA Netw Open 2019; 2:e196253. [PMID: 31225896 PMCID: PMC6593961 DOI: 10.1001/jamanetworkopen.2019.6253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/08/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States. Objective To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom. Design, Setting, and Participants This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018. Main Outcomes and Measures Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns. Results A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]). Conclusions and Relevance Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.
Collapse
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | | | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Jordan Tchilingirian
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| |
Collapse
|
38
|
Experiences of Dermatologic Surgeons With the Sunshine Act: A National Survey. Dermatol Surg 2019; 45:864-867. [DOI: 10.1097/dss.0000000000001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
39
|
What Do Plastic Surgery Patients Think of Financial Conflicts of Interest and the Sunshine Act? Ann Plast Surg 2019; 82:597-603. [DOI: 10.1097/sap.0000000000001756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Wong VSS, Avalos LN, Callaham ML. Industry payments to physician journal editors. PLoS One 2019; 14:e0211495. [PMID: 30730904 PMCID: PMC6366761 DOI: 10.1371/journal.pone.0211495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background Open Payments is a United States federal program mandating reporting of medical industry payments to physicians, increasing transparency of physician conflicts of interest (COI). Study objectives were to assess industry payments to physician-editors, and to compare their financial COI rate to all physicians within the specialty. Methods and findings We performed a retrospective analysis of prospectively collected data, reviewing Open Payments from August 1, 2013 to December 31, 2016. We reviewed general payments (“… not made in connection with a research agreement”) and research funding to “top tier” physician-editors of highly-cited medical journals. We compared payments to physician-editors and physicians-by-specialty. In 35 journals, 333 (74.5%) of 447 “top tier” US-based editors met inclusion criteria. Of these, 212 (63.7%) received industry-associated payments in the study period. In an average year, 141 (42.3%) of physician-editors received any direct payments to themselves including general payments and research payments, 66 (19.8%) received direct payments >$5,000 (National Institutes of Health threshold for a Significant Financial Interest) and 51 (15.3%) received >$10,000. Mean annual general payments to physician-editors was $55,157 (median 3,512, standard deviation 561,885, range 10–10,981,153). Median general payments to physician-editors were mostly higher compared to all physicians within their specialty. Mean annual direct research payment to the physician-editor was $14,558 (median 4,000, range 15–174,440). Mean annual indirect research funding to the physician-editor’s institution (highly valued by academic leaders such as departmental chairs and deans) was $175,282 (median 49,107, range 0.18–5,000,000). The main study limitation was difficulty identifying physician-editors primarily responsible for making manuscript decisions. Conclusions A substantial minority of physician-editors receive payments from industry within any given year, sometimes quite large. Most editors received payment of some kind during the four-year study period. Given the extent of editors’ influences on the medical literature, more robust and accessible editor financial COI declarations are recommended.
Collapse
Affiliation(s)
- Victoria S. S. Wong
- Department of Medicine, John A. Burns School of Medicine at the University of Hawai‘i at Mānoa, Honolulu, Hawaii, United States of America
- Neuroscience Institute, The Queen's Medical Center, Honolulu, Hawaii, United States of America
- * E-mail:
| | | | - Michael L. Callaham
- University of California, San Francisco, California, United States of America
| |
Collapse
|
41
|
Wiersma M, Ghinea N, Kerridge I, Lipworth W. 'Treat them into the grave': cancer physicians' attitudes towards the use of high-cost cancer medicines at the end of life. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:343-359. [PMID: 30460710 DOI: 10.1111/1467-9566.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The prescribing of high-cost cancer medicines at the end of life has become a focus of criticism, due primarily to concerns about the safety, efficacy and cost-effectiveness of these medicines in this clinical context. In response to these concerns, a number of interventions have been proposed - frequently focused on improving physician-patient communication at the end of life. Underpinning these strategies is the assumption that the prescribing of high-cost cancer medicines at the end of life is primarily the result of poor communication on the part of cancer physicians. In this paper, we explore the factors perceived by cancer physicians to be driving the use of high-cost cancer medicines at the end of life. Drawing on semi-structured interviews with 16 Australian oncologists and haematologists, we demonstrate that these physicians believe that the use of high-cost medicines at the end of life is driven by multiple factors - including individual, interpersonal, socio-cultural and public policy influences. We conclude that these factors, and their interactions, need to be taken into account in the development of public policy and clinical interventions to address the use of high-cost medicines at the end of life.
Collapse
Affiliation(s)
- Miriam Wiersma
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Narcyz Ghinea
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
- Haematology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
42
|
Na X, Guo H, Zhang Y, Shen L, Wu S, Li J. Mining Open Payments Data: Analysis of Industry Payments to Thoracic Surgeons From 2014-2016. J Med Internet Res 2018; 20:e11655. [PMID: 30504119 PMCID: PMC6294877 DOI: 10.2196/11655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/07/2018] [Accepted: 10/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background The financial relationship between physicians and industries has become a hotly debated issue globally. The Physician Payments Sunshine Act of the US Affordable Care Act (2010) promoted transparency of the transactions between industries and physicians by making remuneration data publicly accessible in the Open Payments Program database. Meanwhile, according to the World Health Organization, the majority of all noncommunicable disease deaths were caused by cardiovascular disease. Objective This study aimed to investigate the distribution of non-research and non-ownership payments made to thoracic surgeons, to explore the regularity of financial relationships between industries and thoracic surgeons. Methods Annual statistical data were obtained from the Open Payments Program general payment dataset from 2014-2016. We characterized the distribution of annual payments with single payment transactions greater than US $10,000, quantified the major expense categories (eg, Compensation, Consulting Fees, Travel and Lodging), and identified the 30 highest-paying industries. Moreover, we drew out the financial relations between industries to thoracic surgeons using chord diagram visualization. Results The three highest categories with single payments greater than US $10,000 were Royalty or License, Compensation, and Consulting Fees. Payments related to Royalty or License transferred from only 5.38% of industries to 0.75% of surgeons with the highest median (US $13,753, $11,992, and $10,614 respectively) in 3-year period. In contrast, payments related to Food and Beverage transferred from 93.50% of industries to 98.48% of surgeons with the lowest median (US $28, $27, and $27). The top 30 highest-paying industries made up approximately 90% of the total payments (US $21,036,972, $23,304,996, and $28,116,336). Furthermore, just under 9% of surgeons received approximately 80% of the total payments in each of the 3 years. Specifically, the 100 highest cumulative payments, accounting for 52.69% of the total, transferred from 27 (6.05%) pharmaceutical industries to 86 (1.89%) thoracic surgeons from 2014-2016; 7 surgeons received payments greater than US $1,000,000; 12 surgeons received payments greater than US $400,000. The majority (90%) of these surgeons received tremendous value from only one industry. Conclusions There exists a great discrepancy in the distribution of payments by categories. Royalty or License Fees, Compensation, and Consulting Fees are the primary transferring channels of single large payments. The massive transfer from industries to surgeons has a strong “apical dominance” and excludability. Further research should focus on discovering the fundamental driving factors for the strong concentration of certain medical devices and how these payments will affect the industry itself.
Collapse
Affiliation(s)
- Xu Na
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haihong Guo
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Zhang
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liu Shen
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sizhu Wu
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information / Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
43
|
Mulinari S, Ozieranski P. Disclosure of payments by pharmaceutical companies to healthcare professionals in the UK: analysis of the Association of the British Pharmaceutical Industry's Disclosure UK database, 2015 and 2016 cohorts. BMJ Open 2018; 8:e023094. [PMID: 30344175 PMCID: PMC6196800 DOI: 10.1136/bmjopen-2018-023094] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse the section of Disclosure UK that pertains to healthcare professionals (HCPs) in order to provide insight into the database's structure and content and suggest ways to improve its transparency. DESIGN AND PARTICIPANTS Cohort study of drug companies and HCPs in the 2015 and 2016 versions of Disclosure UK. RESULTS Companies report transfers of value (ToVs) to named HCPs or, where an HCP declines to consent, in aggregate. Only a limited number of variables describe the recipient HCP and the ToV, precluding refined analyses. In 2015, 107 companies reported 54 910 ToVs worth ₤50 967 728. In 2016, 109 companies reported ToVs but spending decreased by 7.3%. The spending was concentrated: the top 10 spenders reported about 50% of the total value, with consultancy-related payments comprising over 70%, and the rest being costs for events. In 2015, 55.5% (30 478) of ToVs worth ₤24 428 619 (47.9%) were disclosed at the individual HCP level, increasing to 64.5% (32 407) and ₤28 145 091 (59.2%) in 2016. Despite increased individual-level disclosure in 2016, the median number of ToVs reported by each company at the individual level was only 57.7%, with 25% of companies reporting less than 38.6%. We found little agreement (62%-48% in 2015 and 46%-30% in 2016) between HCP consent rates that we calculated based on information in the database and those provided by companies. CONCLUSIONS Key deficiencies in Disclosure UK include: insufficient information on payments and recipients, a relatively low HCP consent rate for individual-level disclosure, differences in consent rates across companies and payment types, and reporting ambiguities or inconsistencies. We employ these findings to develop recommendations for improving transparency, including an easily interpretable consent rate statistic that allows for comparison across years, firms and countries. If deficiencies remain unresolved, the UK should consider introducing legislation requiring mandatory disclosure to allow for adequate tracking of industry payments.
Collapse
Affiliation(s)
- Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| |
Collapse
|
44
|
Morse E, Fujiwara RJT, Mehra S. Industry Payments to Physicians and Prescriptions of Brand-Name Proton-Pump Inhibitors. Otolaryngol Head Neck Surg 2018; 160:70-76. [PMID: 30325706 DOI: 10.1177/0194599818803337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize the association between industry payments and prescriptions of 2 brand-name proton-pump inhibitors (PPIs). STUDY DESIGN Cross-sectional retrospective. SETTING Physicians nationwide. SUBJECTS AND METHODS We identified all physicians receiving industry payments for Dexilant and Nexium 2014-2015 from the Open Payments database. We linked this to records of prescriptions for PPIs paid for by Medicare Part D these same years and compared the proportion of prescriptions written for Dexilant and Nexium in industry-compensated vs nonindustry compensated physicians. The number and dollar amount of payments were associated with the rate of drug prescriptions. RESULTS We identified 254,452 physicians prescribing PPIs; 8586 and 2766 physicians received industry payments for Dexilant and Nexium, respectively. A total of 5052 of 7876 (64%) physicians compensated for Dexilant prescribed Dexilant vs 39,778 of 246,571 (16%) noncompensated physicians ( P < .001). For Nexium, 2525 of 2654 (95%) compensated physicians prescribed Nexium, compared to 123,913 of 252,067 (49%) noncompensated physicians. For both Dexilant and Nexium, there was a significant correlation between the number (ρ = 0.22, P < .001 and ρ = 0.12, P < .001) and dollar amount (ρ = 0.22, P < .001 and ρ = 0.13, P < .001) of payments and the percentage of prescriptions written for the compensated drug. Industry payments for Nexium remained associated with rate of prescription even after generic esomeprazole became available. CONCLUSION Both the number and dollar amount of industry payments were associated with increased prescriptions for both Dexilant and Nexium. Although unable to show causality, this study suggests that industry payments may increase physician prescriptions of costly, brand-name drugs.
Collapse
Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,2 Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
45
|
Ahmed AA, Yoo SK, Mehta S, Holliday EB, Deville C, Vapiwala N, Wilson LD, Jagsi R, Prasad V, Thomas CR. Meaningful and Accurate Disclosure of Conflict of Interest at the ASTRO National Meeting: A Need for Reassessment of Current Policies. J Oncol Pract 2018; 14:JOP1800121. [PMID: 30260714 DOI: 10.1200/jop.18.00121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
PURPOSE: Conflict of interest (COI) disclosure is essential to research integrity. The average reading comprehension in English is 3.8 words per second (wps). This study examines presenters at the American Society for Radiation Oncology (ASTRO) national meeting over a recent 3-year period to determine whether disclosure is presented accurately and in a manner that allows the audience to comprehend the content. METHODS: We examined videos of presentations as well as slides from 2014 to 2016 from the ASTRO virtual meeting, noting whether a COI slide was presented, the duration the slide was visible, and the number of disclosures. Disclosures were cross-referenced for discrepancies with the publicly reported Centers for Medicare and Medicaid Services Open Payments database. Using a cutoff of 4 wps, we noted how many presentations were presented at speeds of ≤ 4 wps and > 4 wps. RESULTS: The final data set consisted of 401 presentations delivered by 364 presenters. Using a threshold of 4 wps, 34.0% of presenters had COI slides shown too fast for the average audience to comprehend. Moreover, 16.3% of US physicians incorrectly underreported industry funding received. Of these presentations with discrepancies, 32.6% did not have a COI slide, 39.5% failed to disclose any COI, 27.9% partially disclosed COIs, and 11.6% contained multiple discrepancies. The number of wps were correlated with having a discrepancy on multivariable regression ( P = .046; odds ratio, 1.08; 95% CI, 1.01 to 1.19). CONCLUSION: A substantial minority of presentations at ASTRO lack meaningful disclosure, and a surprising number incorrectly reported COIs. Additional guidance may be needed to promote more meaningful and accurate disclosure of COIs at major national meetings in oncology.
Collapse
Affiliation(s)
- Awad A Ahmed
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Stella K Yoo
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Shahil Mehta
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Emma B Holliday
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Curtiland Deville
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Neha Vapiwala
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Lynn D Wilson
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Reshma Jagsi
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Vinay Prasad
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| | - Charles R Thomas
- University of Miami Miller School of Medicine; Sylvester Comprehensive Cancer Center; Jackson Memorial Hospital, Miami, FL; University of Southern California Keck School of Medicine, Los Angeles, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Johns Hopkins University, Baltimore, MD; University of Pennsylvania, Philadelphia, PA; Yale School of Medicine, New Haven, CT; University of Michigan, Ann Arbor, MI; and Oregon Health and Science University, Portland, OR
| |
Collapse
|
46
|
Zaorsky NG, Ahmed AA, Zhu J, Yoo SK, Fuller CD, Thomas CR, Choi M, Holliday EB. Industry Funding Is Correlated With Publication Productivity of US Academic Radiation Oncologists. J Am Coll Radiol 2018; 16:244-251. [PMID: 30219342 DOI: 10.1016/j.jacr.2018.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Industry payments to physicians are financial conflicts of interest and may influence research findings and medical decisions. We aim to (1) characterize industry payments within radiation oncology; and (2) explore the potential correlation between receiving disclosed industry payments and academic productivity. MATERIALS/METHODS CMS database was used to extract 2015 industry payments. For academic radiation oncologists, research productivity was characterized by h- and m-indices, as well as receipt of National Institutes of Health (NIH) funding, which is not an industry payment. Logistic regression models were used to determine whether publication metrics (m-index, h-index) and other study characteristics such as gender, PhD status, NIH institution funding status, were associated with the endpoints, research and general payments. Associations between the amount of payments (if any) and publication metrics were further studied using linear regression models. RESULTS A total of 22,543 individual payments totaling $25,532,482 to 2,995 radiation oncologists were included. Among the 1,189 academic radiation oncologists, 75% received less than $167; on the other hand, 10 (<1%) individuals received $6,425,728 (51%) of payments. On multiple logistic regression, research payments were significantly associated with the m-index, odds ratio 2.86 (95% confidence interval, 1.84-4.45, p-value <0.0001); as well as with the h-index, odds ratio 1.03 (95% confidence interval, 1.01-1.05, p-value <0.0001). The linear regression model shows that both m-index and h-index were significantly positively associated with the amount of general payments (p-values <0.0001). CONCLUSION There is an association between disclosed payment from the industry and increased individual research productivity metrics. Further research to find the cause behind this association is warranted.
Collapse
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Awad A Ahmed
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, Oregon
| | - Mehee Choi
- Department of Radiation Oncology, Loyola University Chicago, Chicago, Illinois
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
47
|
The Accuracy of Conflict-of-Interest Disclosures Reported by Plastic Surgeons and Industry. Plast Reconstr Surg 2018; 141:1592-1599. [DOI: 10.1097/prs.0000000000004380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Fu MC, Boddapati V, Nwachukwu BU, Ranawat AS, Albert TJ, Dines JS. Conflict-of-Interest Disclosures to The Journal of Bone & Joint Surgery: The Relevance of Industry-Reported Payments. J Bone Joint Surg Am 2018; 100:e51. [PMID: 29664860 DOI: 10.2106/jbjs.17.00492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Academic journals such as The Journal of Bone & Joint Surgery (JBJS) require disclosures of financial relationships that authors report as potential conflicts of interest. Because industry payments can take various forms, including food and beverage, consulting, or research payments, the purpose of this study was to determine which categories of industry-reported payments were most frequently considered by authors as irrelevant to their specific publication, and therefore not included in their journal disclosures. METHODS Author disclosures were collected from scientific articles published in JBJS in 2016. Payments reported by authors as relevant to the published article were compared with industry-reported payments from the Centers for Medicare & Medicaid Services Open Payments Database (OPD), which includes all payments to eligible physicians in the United States. The number of authors with payments found in the OPD and appearing in publication-specific disclosures was determined for each payment type. Of note, OPD data are not indicative of relevance to a particular publication; therefore, the accuracy of author disclosures could not be determined in this study. RESULTS A total of 747 eligible authors were included; 60.5% of authors did not report at least 1 payment from their OPD report in their publication-specific disclosures, most frequently representing industry payments for food and beverage (55.7%), followed by travel and lodging (26.9%). Payments for consulting (16.3%), royalties (8.2%), research (8.4%), and ownership interests (1.5%) were not considered to be relevant disclosures for specific journal articles by authors at lower rates than those for food and beverage and for travel and lodging. CONCLUSIONS Authors publishing in JBJS were more likely to conclude that industry-reported payments in the OPD for food and beverage and for travel and lodging were irrelevant for specific publications (as disclosed to the journal) than payments for consulting, royalties, research, and ownership interests.
Collapse
|
49
|
Purvis TE, Lopez J, Milton J, May JW, Dorafshar AH. Plastic Surgeons' Perceptions of Financial Conflicts of Interest and the Sunshine Act. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1733. [PMID: 29876177 PMCID: PMC5977953 DOI: 10.1097/gox.0000000000001733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is unknown whether recent legislation known as the Physician Payments Sunshine Act has affected plastic surgeons' views of conflicts of interest (COI). The purpose of this study was to evaluate plastic surgeons' beliefs about COI and their comprehension of the government-mandated Sunshine Act. METHODS Plastic surgeon members of the American Society of Plastic Surgeons were invited to complete an electronic survey. The survey contained 27 questions that assessed respondents' past and future receipt of financial gifts from industry, awareness of the Sunshine Act, and beliefs surrounding the influence of COI on surgical practice. RESULTS A total of 322 individuals completed the survey. A majority had previously accepted gifts from industry (n = 236; 75%) and would accept future gifts (n = 181; 58%). Most respondents believed that COI would affect their colleagues' medical practice (n = 190; 61%) but not their own (n = 165; 51%). A majority was aware of the Sunshine Act (n = 272; 89%) and supported data collection on surgeon COI (n = 224; 73%). A larger proportion of young surgeons believed patients would benefit from knowing their surgeon's COI (P = 0.0366). Surgeons who did not expect COI in the future believed financial COI could affect their own clinical practice (P = 0.0221). CONCLUSIONS Most plastic surgeons have a history of accepting industry gifts but refute their influence on personal clinical practice. Surgeon age and anticipation of future COI affected beliefs about the benefits of COI disclosure to patients and the influence of COI on surgical practice.
Collapse
Affiliation(s)
- Taylor E. Purvis
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Joseph Lopez
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md
| | | | - James W. May
- Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Mass
| | - Amir H. Dorafshar
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md
| |
Collapse
|
50
|
Maruf M, Agarwal PK, Sidana A. The Sunshine Act and oncology: Lessons learned from urology. Semin Oncol 2018. [PMID: 29526254 DOI: 10.1053/j.seminoncol.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The Physician Payment Sunshine Act was enacted to increase the transparency of financial relationships between physicians and the pharmaceutical industry. These financial relationships are prevalent in the field of oncology, as they are in other fields of medicine. We explored the relationship between industry and urologists for compensations associated with the treatment of urologic malignancies. METHODS The publicly available Open Payments database was obtained from the Centers for Medicare & Medicaid Services. We performed a descriptive analysis of payments made to urologists for drugs associated with urologic malignancies. RESULTS In total, 44,334 payments, summing to $ 4,638,856, were made to 5,666 urologists for drugs used to treat urologic cancers. The median payment per transaction was $14, and most (74.3%) were £ $20. Of the transactions, 39,368 (88.8%) were associated with drugs for prostate cancer, 3,475 (7.8%) for bladder cancer, and 1,491 (3.4%) for kidney cancer. Most payments were made the form of food or beverage (89%), equating to $826,667. CONCLUSIONS For urologists, industry payments associated with cancer treatment are prevalent. Treatments for prostate cancer are associated with the most financial relationships, followed by bladder cancer and kidney cancer. Payments are small in amount, and are commonly in the form of food or beverage.
Collapse
Affiliation(s)
- Mahir Maruf
- Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Baltimore, MD; National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, MD
| | - Piyush K Agarwal
- National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, MD
| | - Abhinav Sidana
- National Cancer Institute, National Institutes of Health, Urologic Oncology Branch, Bethesda, MD; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of Urology, University of Cincinnati School of Medicine, Cininnati, OH.
| |
Collapse
|