Although it’s always important to remember in research studies that associations don’t prove causation, findings from two separate works should raise serious concerns about doctors’ independence and judgment in prescribing drugs and reporting conflicts of interest about payments from makers of medical devices.
That’s because doctors who get money from drug makers in connection with a specific medication tend to prescribe that drug “more heavily” than colleagues who don’t get similar cash, ProPublica, a Pulitzer Prize-winning investigative site, has found.
And doctors who are among those receiving the highest compensation from surgical and medical device manufacturers show some of the biggest discrepancies between the sums they report for institutional conflicts of interest and what a federal database of payments shows, according to physician-researchers at the University of California, Irvine (UCI).
The journalists and the medical scientists both take pains to emphasize that they cannot show the firm tie that M.D.s getting money from Big Pharma or device makers affects how they prescribe drugs or make crucial declarations about their conflicts of interest.
As the saying goes, though: If it looks like a duck, quacks like a duck, and flies like a duck, it’s a duck, right?
Other similar research also lends support to the disturbing findings about money’s corruptive influence on doctors and how it can affect and harm patient care.
The ProPublica analysis, a long-term push by deep-digging reporters, focused on “widely prescribed brand-name drugs in Medicare, including drugs that treat diabetes, asthma and more. The financial interactions include payments for delivering promotional talks, consulting and receiving sponsored meals and travel. The 50 drugs in our analysis include many popular and expensive ones. Thirty-eight of the drugs have yearly costs exceeding $1,000 per patient, and many topped the list that are most costly for the Medicare Part D drug program.”
As ProPublica found:
“On average, across all drugs, providers who received payments specifically tied to a drug prescribed it 58% more than providers who did not receive payments. Other research, including our own, has found a correlation between payments and overall prescribing. This new analysis expands upon past work by looking individually at a variety of popular drugs. ‘What clearly jumps out is how consistent the association is across drugs,’ said Aaron Mitchell, a medical oncologist at Memorial Sloan Kettering Cancer Center who has studied pharmaceutical payments for oncology drugs. Our analysis looked at the relationship in two ways: whether those who received payments prescribed more of a drug, as well as whether those who prescribed a drug received higher payments than those who did not. We found that, on average, physicians who prescribed a drug received higher payments related to the drug that same year than those who didn’t prescribe it.”
Doctors and drug makers defended their prescribing practices and payment relationships. They said the exchange of information among them, which is paid for, is helpful and useful. Doctors argued that they prescribe drugs that work, and they said it makes sense for them to share with colleagues the value of specified medications.
But ProPublica noted:
“Experts are skeptical that interactions between companies and doctors benefit patients. ‘If there really were innovations and real benefits that were accruing to patients for a new treatment, it shouldn’t take so much spending by the company to get the word out,’ said Stacie B. Dusetzina, associate professor of health policy at Vanderbilt University Medical Center, who advised ProPublica on the design of its analysis. ‘I wonder if promotion is really to try to push products that have a much less substantial benefit because they’re not gaining the market share naturally.’”
The news organization provided information on how it conducted its work:
“ProPublica’s analysis matched doctors’ prescribing in Medicare’s prescription drug program to the industry payments doctors received. Drug and medical device companies are required to report these payments annually through the federal Open Payments program, and they are made public on a government website. More than 600,000 doctors receive payments annually. (Companies also report research payments and ownership interests, but these were excluded from our analysis.) Some providers were paid thousands of dollars, often for promotional speaking. But the typical doctor took in much less. Most only received meals, typically worth less than $100 per year.”
Studies have found that doctors appear to be swayed in their prescribing by cheap swag and inexpensive meals — perhaps the company of congenial drug salespeople and a pizza lunch does the trick.
A lack of candor in disclosing payments from medical device makers poses big risks to the integrity of published research, the UCI experts said in the work, published on the JAMA Network, with an accompanying editorial calling for greater transparency to protect studies’ credibility.
Hospitals, research institutions — notably universities and medical schools — respectable medical journals, and excellent practitioners insist on robust disclosures of conflicts of interest, including reports in the Open Payments database.
The UCI team, however, reported that the conducted an “analysis of the 100 physicians receiving the highest compensation from 10 large surgical and medical device manufacturers [and] used payment information from the Centers for Medicare & Medicaid Services Open Payments Database. Conflicts of interest were declared by the authors in only 84 of 225 of the relevant 2016 publications (37.3%).” This “large discrepancy between self-declared conflict of interest and the Open Payments Data among the physicians receiving the highest compensation from surgical and medical device manufacturers needs to be addressed.”
Their targeted study group included “100 physicians … (88% men) [who] were paid a total of $12, 446, 969, with a median payment of $95, 993. Fifty physicians (50.0%) were faculty at academic institutions.” They published extensively.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by dangerous drugs and by defective and dangerous products, notably of the medical kind. It is tiresome that Big Pharma and device makers persist in crying “poor us,” even as they gouge patients on costs, push relentlessly to reduce desperately needed oversight, and don’t seem to care much for their most important customers — us.
Just read the annual comparisons of costs of prescription drugs and medical services in this country versus other nations, and see if you don’t get mad.
As Margot Sanger-Katz reported in the New York Times’ “Upshot”column: “Why does health care cost so much more in the United States than in other countries? As health economists love to say: ‘It’s the prices, stupid.’” She, for example, says that:
“For a typical angioplasty, a procedure that opens a blocked blood vessel to the heart, the average U.S. price is $32,200, compared with $6,400 in the Netherlands, or $7,400 in Switzerland, the survey finds. A typical M.R.I. scan costs $1,420 in the United States, but around $450 in Britain. An injection of Herceptin, an important breast cancer treatment, costs $211 in the United States, compared with $44 in South Africa. These examples aren’t outliers.”
Besides their costs for research and development, of course, Big Pharma and device makers have not only used big spending and marketing and advertising to push their wares in relentless fashion, they also have pumped big money into persuading doctors and politicians about their products and how they need to be promoted in the profession and to the public.
They also have clamored with success for less oversight — which now is occurring at “breakneck speed,” with official reviews that are occurring at such pace that companies themselves are stunned at the turnaround and approval. Big Pharma is pushing for even more, with the Wall Street Journal reporting that firms are proposing to mine Big Data from patients’ health records, rather than conducting randomized clinical trials — the rigorous testing that is the “gold standard” of careful science. Federal regulators, meantime, have allowed a “Wild, Wild West” to flourish in the area of medical devices, including helping businesses hide more than 1 million reports of patient harms.
Still, when it comes to some key medications that change and save lives, Big Pharma is either extracting unspeakable prices, still, as is the case with insulin. Or firms, in tandem with avaricious investors, are finding a no-go business in supplying existing antibiotics or creating new and desperately needed bug killers, as the New York Times reported. Cut a finger and get a nasty infection, or come down with a common and pesky urinary tract infection and the overuse and abuse of the “miracle” germ killers — combined with Big Pharma’s putting profits ahead of people — may put your health and even your life at risk, as doctors and public health officials see the world in a “post antibiotic” world now.
We’ve got a lot of work to do to keep Big Pharma and device makers in check and to ensure prescription drugs and medical devices stay safe, affordable, and efficient.