Critics often target physicians who receive money from pharma, but the exact influence those payments have on prescribing is up for debate. In oncology, at least, it’s not one-off payouts but consistent compensation that's most likely to sway prescribing behavior, a new study found.
Published in the journal The Oncologist, the study showed that physicians who received payments over three consecutive years and tied to a specific drug boosted their prescriptions of that product. That pattern applied to oral drugs that treat lung cancer, kidney cancer and chronic myeloid leukemia, but not prostate cancer. Among physicians who received payments from drug companies during only one year, no pattern emerged.
The researchers evaluated payments made to 2,766 physicians between 2013 and 2015. They found that the average amount earned by physicians who took payments over all three years was $5,881, compared with $553 for those paid during one year only. Among the drugs boosted by drug-company largesse were Pfizer’s Inlyta and Novartis’ Afinitor to treat renal cell cancer, and Roche’s Tarceva for lung cancer.
“These findings add to a growing body of work that suggests physicians are more likely to use drugs made by companies that have given them money in the past,” said lead author Aaron Mitchell, M.D., a medical oncologist in the department of epidemiology and biostatistics at Memorial Sloan Kettering Cancer Center, in a statement.
Physicians can receive payments from companies for activities ranging from sponsored meals, during which they talk up specific drugs, to consulting fees, to plane tickets and hotel rooms for medical conferences. The authors of the new study found that consulting fees and travel expenses were more likely to spark increased prescribing than were other types of compensation.
Over the last decade, lawmakers have become increasingly concerned about conflicts of interest (COI) in medicine, leading to federal legislation that requires companies to disclose those payments. Several hospitals and research institutions have adopted COI policies that require physicians to disclose their financial relationships with companies and in some cases to limit those paid interactions.
Mitchell and his co-authors took this trend into consideration in their analysis, examining the relationship between COI rules and physician payments. But they found no clear link between COI policies and physician prescribing behavior.
Does that mean COI rules are completely ineffective? Not necessarily, the authors said. But it does raise questions about the extent to which those policies are actually being enforced. “It is also possible that COI policies may need to be significantly more stringent before changes” in prescribing practices can occur, they wrote.
The controversy over physician payments has engulfed numerous players in the healthcare industry, including Mitchell’s hospital, Memorial Sloan Kettering. It became a target of scrutiny last year, when reports emerged that its then-chief medical officer, José Baselga, M.D., Ph.D., did not properly disclose financial relationships with drug companies that netted him millions.
Some companies have responded to the ongoing controversy by adopting new transparency practices. Last year, for example, AstraZeneca said it would start disclosing all financial relationships with physicians, even in countries that don’t require it. The company had already been making those disclosures in the U.S., Europe, Australia and Japan, and it plans to add 11 countries this year, a spokesman told FiercePharma at the time.
The authors of the new study suggest that more research like theirs should be done to better understand the effects of physician payments both inside and outside of oncology. “Public scrutiny of the industry role in cancer research and care delivery remains high,” Mitchell and his co-authors concluded. “Ideally, institutions may increasingly be able to rely on research findings in order to construct informed, data-driven policies to manage industry relationships within this changing environment.”