HERSHEY, Pa. — Financial conflicts of interest may influence medical practice and research and may erode patient trust in medical professionals. According to a new analysis of the Open Payments platform, a database that tracks payments between physicians and industry, these relationships remain pervasive. A team led by a Penn State researcher found that doctors received approximately $12.1 billion from drug and device makers between 2013 and 2022. Their findings were reported in a research letter published last week (March 28) in JAMA.
"This is the first to look at the data longitudinally and by specialty,” said Andrew Foy, associate professor of medicine, Penn State College of Medicine and corresponding author on the research letter.
The Physician Payments Sunshine Act was passed in response to calls for greater transparency on financial relationships between physicians and teaching hospitals and the makers of drugs and medical devices. It led to the creation of the Open Payments database. Beginning in August 2013, manufacturers have been required to submit information on all payments and transfers of value.
Data from Open Payments can provide insight on the extent of the financial relationships between physicians and industry. However, the question of whether greater transparency would change behavior or mitigate bias remains. The current analysis suggests that mandatory reporting hasn’t changed the financial relationships between physicians and industry.
“Overall, it shows that the Open Payments is not much more than a ledger sheet,” Foy said. “Whether there is a need for deterrence or changed behaviors requires a broader conversation with public involvement.”
For this paper, the team used data from Open Payments from 2013 to 2022. They included payments, both cash and non-cash equivalents, to physicians for consulting services, non-consulting services, food and beverages, travel and lodging, entertainment, education, gifts, grants, charitable contributions and honoraria. They analyzed data across 39 specialties. They also looked at within-specialty variation — the difference between the median amount paid to physicians in a specialty and the mean amount paid to the top 0.1% of physicians in that specialty. Lastly, they determined the 25 drugs and medical devices associated with the largest total payments.
The analysis showed that more than half of physicians received at least one payment and roughly 94% of payments were associated with one or more marketed medical products. A small percentage of physicians received the largest amounts, often exceeding $1 million. Orthopedic surgeons received the greatest sum of payments while pediatric surgeons received the least amount.
Other authors on the paper are Ahmed Sayed from Ain Shams University, Joseph Ross from Yale School of Medicine, John Mandrola from Baptist Health, Lisa Soleymani Lehmann from Harvard Medical School.
This project was not supported by external grants or funds.