Neil Osterweil

July 03, 2016

BOSTON — Optometrists in the United States accepted more than $18.2 million in cash, cash equivalent, or in-kind payments in the first year of mandatory reporting under the Physician Payments Sunshine Act, according to a retrospective review.

And "the evidence is very clear that when industry marketing takes place, it does influence prescribing behavior," said Erik Mothersbaugh, OD, a clinical instructor at the Illinois College of Optometry in Chicago.

Per physician payments ranged from a miniscule $1 in value to a breathtaking $406,392. Of the $18.3 million paid out by industry, $13.2 million went to the top 10% of payment recipients, Dr Mothersbaugh reported here at Optometry's Meeting by the American Optometric Association (AOA).

As can be seen from these results, financial influence in optometry is widespread. "Approximately 90% of the profession is participating in some fashion, but the vast majority of money is going to a relative minority of providers," he explained.

Although a minority of physicians surveyed said they believe industry involvement creates a conflict of interest, the majority think they are able to escape that influence in their own drug selection, he noted.

 
The vast majority of money is going to a relative minority of providers
 

The Sunshine Act requires that manufacturers of drugs, devices, and biological or medical supplies covered by Medicare and other government insurance plans annually report "payments or transfers of value provided to physicians or teaching hospitals" to the Centers for Medicare and Medicaid Services (CMS).

The data collected by the CMS can be searched at OpenPaymentsData.CMS.gov.

In their retrospective review of these data, Dr Mothersbaugh and his colleagues looked at all general payments made to optometric physicians in 2014.

General payments include cash or cash equivalent (for example, consulting fees, speaking fees, honoraria, and/or royalties) and in-kind items and services (food and beverage, travel and lodging, and education).

The researchers identified 36,426 optometrists on the receiving end of 165,035 financial transactions totaling $18,289,817. The average transaction value was $111, and the average payment per physician was $502.

But a staggering $13,166,996 (72% of total payments) went to physicians in the highest 10% of payment recipients.

"You get these people at the top who are essentially taking second, third, fourth salaries from the industry, and then a bunch of others on the lower end," said Dr Mothersbaugh.

Effect on Prescribing Behavior

A review of 29 published studies of physician interactions with drug companies by Ashley Wanza, MD, from McGill University in Montreal, showed that physicians who met with drug reps were more likely to request that the drugs be added to the hospital formulary and to change prescribing practice, Dr Mothersbaugh reported (JAMA. 2000;283:373-380).

"Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing," Dr Wanza wrote.

In a recent experiment, some medical residents were placed in an otherwise empty room and asked to fill out a questionnaire about prescribing patterns for hypertension, and others were placed in an identical room with a single advertisement for an anti-hypertensive agent.

"Even that one advertisement in a room led to increased decision making for that drug over the others," Dr Mothersbaugh said.

He said he is not sure why optometry has been late to the dance when it comes to acknowledging potential conflicts of interest.

"One theory that I've thrown around — this is just anecdotal — is that as an industry we have some pretty significant ties to cosmetics and fashion," Dr Mothersbaugh told Medscape Medical News.

"Contact lenses and glasses are elements of our practice that are inherently more product-oriented than some medical professions, and that may have some impact. But when it comes to drugs and ordering tests and devices, the medical management is no different than any other medical profession," he explained.

Optometrists need to be aware of the potential for bias in prescribing on the basis of industry-sponsored activities, said Dominick Maino, OD, professor of pediatrics and binocular vision at the Illinois College of Optometry and Illinois Eye Institute in Chicago, who moderated a session highlighting the top 5 poster presentations from the meeting.

"What Dr Mothersbaugh and his colleagues have done is in many ways optometry's first step toward taking a look at us as a profession," he told Medscape Medical News. "Obviously, medicine has been doing this a while."

However, he confessed, "I have mixed feelings. Without industry support — which the AOA appreciates, I appreciate, and everybody I know appreciates — what we do would be that much harder. So the key is to find a mechanism where 1) everything is transparent; 2) you know who is giving what to whom, and 3) it is given in such a way as to minimize undue influence, whether it's on the industry as a whole, an individual organization, or any individual."

The study was internally funded. Dr Mothersbaugh and Dr Maino have disclosed no relevant financial relationships.

Optometry's Meeting by the American Optometric Association (AOA): Poster 89. Presented July 2, 2016.

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