Most Internists Still Report Ties to Industry

Troy Brown, RN

October 10, 2018

Almost three fourths (72%) of internal medicine physicians report ties to prescription drug or medical device manufactures, according to a recent survey.

"While financial industry ties have fallen over the past 15 years, a majority of US physicians still reported them in 2017, most prominently, free samples and meals, the latter of which are usually provided during promotional communications related to a brand-name drug or medical device. Free samples are used as a marketing tool and have been linked to prescribing of high-cost brand-name drugs over lower-cost generic alternatives," the authors write.

The findings were published online October 5 in the Journal of General Internal Medicine by Aaron S. Kesselheim, MD, JD, MPH, from the Program On Regulation (PORTAL), Therapeutics, And Law in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues.

Since 2013, federal law has required physicians to report industry payments and gifts. In addition, some states and healthcare groups, including large academic medical centers and physician employers, have banned or restricted direct marketing to physicians. As a result, many manufacturers have changed their approach to certain gifts.

To learn the effects of those changes, Kesselheim and colleagues conducted a national survey of internal medicine physicians to determine whether their financial relationships with industry have changed in light of these restrictions.

They randomly selected 500 clinically active internists and 1000 internal medicine specialists from the American Board of Internal Medicine's diplomate list. Of the specialists, 500 were endocrinologists and 500 were cardiologists.

Of the 686 (45.7%) physicians who responded, 72% said they had any financial tie to industry. Receipt of free drug samples (55%) was the most frequently reported category, followed by food or beverage in the workplace (48%), and food or beverage outside the workplace (30%). A much smaller percentage of respondents reported receipt of small gifts (8%), fees for consulting (4%), or serving on a scientific advisory board (3%).

During 2017, 60.9% of cardiologists and 53.2% of endocrinologists reported meals at work, compared with 31.8% of internists (P < .0001). Of the physicians, men reported receiving more meals at work than women (52.1% vs 43.2%; P = .03).

Meals outside work were also more common among cardiologists (42.5%) and endocrinologists (34.3%), compared with internists (12.8%; P < .001) and among men vs women (33.8% vs 25.3%; P = .02).

Expertise-related payments such as speaker honoraria (P < .0001), consulting fees (P = .004), and fees for serving on scientific advisory boards (P = .44) were more common among specialists and older physicians.

"These differences were similar to those found in a national physician survey in 2009 with similar questions and response rates," the authors explain.

However, overall fewer internal medicine physicians reported receiving financial payments of all types in 2017 vs 2009. The greatest reductions were for food/beverage or tickets to sporting or cultural events (75% vs 42%; P < .0001) and speakers bureaus/consulting/advisory boards (18% vs 2%; P < .0001).

Among cardiologists, the only significant changes were for drug samples (82% vs 60%; P < .0001) and speakers bureaus/consulting/advisory boards (33% vs 8%; P < .0001).

On average, respondents were aged 44 years (standard deviation [SD], 8) and out of residency for 13 years (SD, 8). Most respondents were men (59%), specialists (72%), and white (56%). Four percent were Hispanic, 34% were Asian, 3% were African American, and 4% were "other".

Limitations of the study include the number of physicians who failed to respond to the survey and possible under-reporting of ties resulting from reluctance to acknowledge industry ties given increased scrutiny.

"The decline in financial ties may reflect successful regulation by states, academic institutions, and large employers, as well as consolidation of more physician practices under these entities, or a consequence of mandatory disclosure under the Sunshine Act. Yet financial connections between physicians and industry remain a prevalent force affecting prescribing practices and healthcare costs," the authors conclude.

The work at PORTAL on this project was funded by the Laura and John Arnold Foundation. Kesselheim also receives support from the Harvard Program in Therapeutic Science and Engelberg Foundation. The Consumer Union paid for survey honoraria and administrative costs. Kesselheim reports serving as an expert witness for plaintiffs in the multidistrict opiate litigation on the subject of pharmaceutical marketing. Two authors cofounded Informulary, a company that provides data about the benefits, harms, and uncertainties of prescription drugs, which ceased operations in 2016. The remaining authors have disclosed no relevant financial relationships.

J Gen Int Med. Published online October 5, 2018. Abstract

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