Been to the doctor lately? Chances are you saw a physician who gets payments from a drug company or medical device maker.
A new study, based on a survey of 1,987 people nationwide in 2014, found that 65 percent were treated by a doctor who had received industry money during a recent 12-month period.
Previous research had found that only 40 percent of physicians receive industry money — funds for meals, travel, and consulting, among other purposes. The difference, according to the new analysis, led by a Drexel University researcher, suggests that doctors who see large numbers of patients are more likely to receive payments.
That may be happening because companies seek to get the most for their money, said lead author Genevieve Pham-Kanter, an assistant professor at Drexel’s Dornsife School of Public Health.
“We wouldn’t be at all surprised if drug companies and device companies were particularly targeting high-volume doctors for promotion and marketing,” said Pham-Kanter, who also is affiliated with the University of Pennsylvania’s Leonard Davis Institute of Health Economics.
As of August 2013, companies are required to report these payments to the federal Centers for Medicare and Medicaid Services, with the goal of allowing consumers to decide whether the funds pose any conflict of interest. Studies have found that doctors who receive payments from drug companies are more likely to prescribe the brand of medication that is being promoted.
The new study, published in the Journal of General Internal Medicine, suggests that transparency can have an impact.
The survey was virtually complete before the federal data became public in September 2014, so most participants could not have known whether their doctors had received industry payments. But three states – Massachusetts, Minnesota, and Vermont – already had their own requirements for public disclosure of such payments. In those states, just 34 percent of patients in the survey reported seeing a physician who had received industry money, about half as many as in the rest of the country.
Pham-Kanter and her coauthors, from Stanford and Harvard Universities, said that with their data, they could not pinpoint the cause of the lower rate in what they called “sunshine” states. Perhaps the disclosure led patients to select different doctors, or maybe some physicians stopped taking industry payments because of publicity, they speculated.
Drawing from the national database, called Open Payments, the study authors analyzed “general” payments that companies made to doctors, a category that does not include funds for research. The median amount received by physicians whose patients were surveyed was $510 from September 2013 through August 2014, meaning that half of them got more and half got less. That total was more than 2.5 times the $193 median for all physicians in the government database.
“Thus, the physicians that patients frequently visited were more likely to have received industry payments and, when they received payments, received amounts greater than were typical of physicians reported in Open Payments,” the authors wrote.
That disparity makes it all the more likely that high-volume physicians were targeted for special treatment, said Michael A. Carome, director of the Health Research Group at Public Citizen, a Washington-based consumer advocacy group.
Carome, who was not involved with the study, used a hypothetical example of two doctors, one who sees 5,000 patients a year, the other seeing 500.
"If you’re the company trying to influence one of these doctors, you put your money toward the one seeing 5,000,” Carome said. “Whether it occurs consciously or subconsciously, this type of flow of things of value to doctors influences their behavior.”
But physicians already make comfortable salaries. Is a few hundred dollars enough to sway the choices a doctor makes in prescribing drugs?
Pham-Kanter said the influence is not necessarily wrought by the money itself, but by what it represents.
“The dollars are indicating some kind of industry contact,” she said. “With gifts and lunches and so on, the money is more a proxy for the kind of interactions and influence and perhaps biased information that could happen with industry contact. It’s not literally that your doctor’s being bought off by a bagel.”