$150K: Average Industry Payment to Top 1% of Oncs

Megan Brooks

June 23, 2022

A small number of US medical oncologists make more than $100,000 a year in general payments from drug companies, a new study shows.

These high-payment physicians represent just 1% of all US medical oncologists, yet they account for 37% of industry payments. These oncologists often hold important leadership positions, draft treatment guidelines, and sit on journal editorial boards.

The findings highlight a risk for "perceived and real conflict of interest," corresponding author Christopher Booth, MD, of Queen's University Cancer Research Center, Kingston, Ontario, Canada, told Medscape Medical News. "Because of the leadership positions they hold, the potential impact of this small group of physicians on oncology practice and policy may be substantial."

The study was published online June 16 in JCO Oncology Practice.

"We Have a Problem"

It's no secret that many oncologists have financial relationships with pharmaceutical companies. They receive payments for research initiatives, but they also receive more general, personal payments in the form of honoraria, consultant fees, gifts, and reimbursement for travel and meals.

Prior studies have shown that these payments are typically modest, but a small subset of medical oncologists receive more than $100,000 annually. Booth and colleagues wanted to know more about the characteristics of these "high-payment" oncologists.

Using the national Open Payments database, the researchers identified a total of 139 medical oncologists who practice in the US and who received $100,000 or more in general payments linked to cancer medications in 2018.

In US dollars, the median payment was $154,613, and the total was $24.2 million.

The majority (95%) of high-payment oncologists were active in clinical work, 56% worked in an academic setting, 31% worked at National Cancer Institute–designated cancer centers, and 23% worked at National Comprehensive Cancer Network (NCCN) centers.

Many were based in California (17%), Texas (12%), Florida (10%), and New York (8%).

Most currently hold or have held hospital leadership positions (60%) or faculty appointments (72%), and 21% have held leadership positions in specialty associations in the past 5 years. Nearly one quarter (24%) have served on journal editorial boards, and 10% have authored clinical practice guidelines in the past 5 years.

More specifically, three physicians authored NCCN guidelines, and two authored American Society of Clinical Oncology guidelines during 2016–2021; one guideline was published in 2018 when payments were made.

"Oncology specialty associations, guideline panels, and journal editorial boards should reconsider if it is appropriate for physicians with such large payments to hold these high-profile positions," Booth said.

Following publication of the study, some oncologists took to Twitter with reactions, including Manni Mohyuddin, MD (@ManniMD1) from the Huntsman Cancer Institute, University of Utah, who wrote: "I recognize that some conflict of interest 'may' be unavoidable in order to run trials. But when greater than TWICE the average American household annual salary is taken in payments from industry by those in leadership/editorial roles we have a problem."

Weighing in on the results, ASCO CEO Clifford A. Hudis, MD, told Medscape Medical News that the "limitations of the study make it difficult to draw conclusions about the scope or potential impact of these payments on care."

For example, he explained, some payments attributed to individuals may have been made directly to the physicians' institutions or employers for sponsored research expenses.

Hudis also noted that the payments examined in the study were made in 2018, whereas the potentially relevant leadership positions could have been attained at a different time.

Furthermore, in 2020, an editorial appeared in Cancer that showed that errors in Open Payments are "fairly common," Hudis said. It's also unclear whether the reported financial relationships were appropriately disclosed and were managed at the time under relevant conflict of interest policies, he said.

"The question left unanswered by this study is whether or not these relationships influence patient care," said Hudis. He noted that decisions about care should come from physicians and patients who are informed of the best available, unbiased, peer-reviewed, scientific evidence.

"The potential impact of financial conflicts of interest on this effort is an issue of concern even if this study does not directly address it," Hudis said.

The study had no specific funding. Booth has disclosed no relevant financial relationships. A complete list of author disclosures is available with the original article. Hudis has disclosed no relevant financial relationships.

JCO Oncol Prac. Published online June 16, 2022. Abstract

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