Many lawmakers worry that when pharma companies pay physicians—for speaking engagements, say, or hotel rooms at conferences—those on the receiving end are more likely to prescribe products from drugmakers that dole out the money.
That concern even sparked a provision in the Affordable Care Act that requires drug and device companies to disclose any physician payment greater than $10.
Researchers led by the University of North Carolina scoured the federal database where those financial disclosures are stored, called Open Payments, and discovered a troubling trend: Oncologists who treat metastatic kidney cancer or chronic myeloid leukemia (CML) were more likely to prescribe drugs made by companies that paid them in 2013. Novartis, Pfizer, Bayer and Bristol-Myers Squibb topped the list of companies benefiting from their largesse to the oncology community.
The biggest association between physician payments and prescribing practices was seen in kidney cancer. The researchers found that physicians who received any industry payment had twice the odds of prescribing that company’s drug, according to the paper, which was published in Jama Internal Medicine.
Of the 354 physicians in the database who prescribe kidney cancer drugs, 89 took pharma money for consulting, meals, travel and other activities. Those payments seemed to track with a boost in prescriptions for Bayer’s Nexavar and Pfizer’s Sutent, though the researchers did state that the study was not designed to prove a direct cause and effect.
A spokeswoman for Bayer said in an email to FiercePharma that the company complies with U.S. disclosure rules on physician payments and "we continuously review and update relevant business processes to comply with the law, in order to ensure that all necessary data is collected, recorded, assessed and transmitted in good time, completely and accurately."
A Pfizer representative said in an email that the company is "committed to meeting the highest ethical standards while working with health care professionals."
"We do not compensate them for anything other than their time and expertise," the spokesperson said. "To suggest otherwise is both misleading and irresponsible.”
Oncologists who treat CML had 29% higher odds of prescribing drugs made by companies who paid them, the UNC researchers found. And when they drilled down into the individual drugs, they made one notable discovery about the Novartis drugs Gleevec and Tasigna. In 2013, as Gleevec was about to lose its patent protection, physician payments seemed to track with a drop in prescriptions for the drug.
That may have been because Novartis was actively trying to switch physicians to the newer drug, Tasigna, the researchers surmised. Indeed, prescribing of Tasigna grew 15.4% among physicians receiving payments from Novartis, vs. 12.5% among those who did not, according to the paper. Gleevec was once Novartis’s best-selling drug, with $4.65 billion in sales in 2015, so the UNC researchers’ suspicion that the company was heavily pushing Tasigna, its next-gen drug tor CML, does make sense.
A spokesperson for Novartis did not immediately respond to a request for comment from FiercePharma.
The UNC team also found a boost in prescribing for BMS’s Sprycel. Oncologists who received payments from the company were 13.8% more likely to prescribe the drug, while prescriptions among those who were not paid went up 11.4%—a statistically significant difference, the researchers said. A spokesperson for BMS did not immediately provide a response to Fierce Pharma.
The researchers examined payments made for research projects separately from funding for other activities and found that the link to prescribing practices was not so black and white. Research funding was more clearly associated with prescribing in kidney cancer but not CML, they concluded.
Nevertheless, some bioethics experts were disturbed when they saw the study. Payments by drug companies to physicians “cloud our ability to remain objective,” said Yoram Unguru from the Johns Hopkins Berman Institute of Bioethics, in an interview with Reuters. He added that the payments could impede “the patient-provider relationship, in particular trust that physicians will place patients’ needs primary.”
Editor's note: This story was updated with statements from Bayer and Pfizer.