Under the Open Payments program (the Physician Payment Sunshine Act, which is part of the Affordable Care Act), the Centers for Medicare & Medicaid Services has published nearly 16 million financial transactions from health care industries to physicians and teaching hospitals for August 2013 through December 2014. The total value of these payments was $9.92 billion. The Centers for Medicare & Medicaid Services will soon publish billions of dollars of additional transactions from 2015. Health care companies are investor-owned businesses that are obliged to maximize profits by any legal means. They are not charities; clearly they believe that billions of dollars of investments will have good returns.
In this issue of JAMA Internal Medicine, DeJong and colleagues,1 using 2013 data from the Open Payments program and prescribing data for individual physicians from Medicare Part D, report an association between receipt of industry-sponsored meals, even just a single meal, and an increased rate of prescribing the brand-name medication that was being promoted. This study adds to the recent report in this journal from Yeh and colleagues,2 using 2011 data, on the association of industry payments to physicians in Massachusetts with higher rates of prescribing brand-name statins. It also adds to the recent analysis by ProPublica, using 2014 Open Payments and Medicare Part D data, showing that “doctors who got money from drug and device makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t” and “the more money doctors receive…the more brand-name drugs they tend to prescribe.”3 In 2014, payments for food and beverages, by far the most frequent type of payment to physicians, totaled $224.5 million.
Although the association between industry payments to physicians and higher rates of prescribing of brand-name medications is not in dispute, none of these studies have established a cause-and-effect relationship. One potential explanation, as DeJong et al1 point out, is that physicians may choose to attend industry events where information is provided about drugs that they already prefer. Other physicians may avoid promotional events. Nonetheless, it is also clear, as the ProPublica analysis showed, that “payments are associated with an approach to prescribing that, writ large, benefits drug companies’ bottom line.”3
The studies by DeJong et al,1 Yeh et al,2 and ProPublica3 raise a broader question. Is it necessary to prove a causal relationship between industry payments to physicians and the prescribing of brand-name medications? Other than research support, product development, and bona fide consulting related to specific research programs and projects, it is already evident that there are few reasons for physicians to have financial associations with industry. Outright gifts, such as meals, may be legal, but why should physicians either expect or accept them?
There are inherent tensions between the profits of health care companies, the independence of physicians and the integrity of our work, and the affordability of medical care. If drug and device manufacturers were to stop sending money to physicians for promotional speaking, meals, and other activities without clear medical justifications and invest more in independent bona fide research on safety, effectiveness, and affordability, our patients and the health care system would be better off.
Conflict of Interest Disclosures: None reported.
Steinbrook R. Industry Payments to Physicians and Prescribing of Brand-name Drugs. JAMA Intern Med. 2016;176(8):1123. doi:10.1001/jamainternmed.2016.2959