The “All Other” category includes payments provided to otolaryngologists by all other health care industry sponsors.
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Rathi VK, Abt NB, Kozin ED, Naunheim MR, Gray ST. Industry Sponsorship of Research in Otolaryngology: An Examination of the Centers for Medicare & Medicaid Services Open Payments Database. JAMA Otolaryngol Head Neck Surg. 2017;143(8):842–843. doi:10.1001/jamaoto.2017.0002
Collaboration between physicians and the health care industry is vital to the development of innovative diagnostics and therapeutics for patient care. However, industry funding of biomedical research has both positive and negative potential implications. Given declines in federal funding,1 the health care industry may serve as an important source of research support. Conversely, industry funding may lead to scientific bias and undue influence on clinical practice.2 The extent of industry support of research in otolaryngology is unknown. This study aimed to quantify research payments made by the health care industry to otolaryngologists and compare the field of otolaryngology to other surgical specialties.
A retrospective cross-sectional analysis of the Centers for Medicare & Medicaid Services Open Payments program 2015 Research Payments data set was performed.3 This data set reports all direct and indirect (ie, disbursed to an affiliated organization) payments provided to physician principal investigators by drug and device manufacturers for research activities, such as clinical study coordination and scientific writing, between January 1, 2015, and December 31, 2015. We excluded individual payments with more than 1 principal investigator from analysis, which accounted for less than .05% of the total value.
After identifying the specialty of each principal investigator, we performed descriptive analyses for each surgical specialty to determine the following: (1) proportion of compensated surgeons; (2) mean and median payment per compensated surgeon; (3) total payment per specialty; and (4) payment type (cash or equivalent/in-kind items and services). The number of active surgeons in each specialty was obtained from the Association of American Medical Colleges 2014 Physician Specialty Databook. For otolaryngology, the total research payment attributable to each sponsor was tabulated and descriptive analysis was performed.
In 2015, drug and device manufacturers provided 2933 payments worth $8 355 091 to 171 otolaryngologists. Payment was primarily provided as cash or equivalent (89.0%), with the remainder provided as in-kind items or services (11.0%), such as donated study equipment. The mean payment per compensated otolaryngologist ($48 860) was nearly 10-fold greater than the median ($5096; 10th-90th percentile, $169-$102 900), indicating that a small number of top earners were compensated well above the median and accounted for a disproportionately large share of payment to otolaryngologists (ie, positive skew). The top 15 highest-paying industry sponsors accounted for the large majority (84.8%) of payment value and featured manufacturers with products indicated for sinonasal and otologic conditions (Figure).
Among surgical specialties, otolaryngology had the second-lowest proportion of compensated surgeons (1.83%), which was approximately 6-fold lower than the highest proportion (vascular, 11.34%). In addition, otolaryngology had the second lowest median payment per compensated surgeon, which was nearly 4-fold lower than the highest payment (ophthalmology, $19 487; 10th-90th percentile, $2318-$156 724). Positive skew owing to top earners and predominance of cash payments were present across all surgical specialties (Table).
Health care industry sponsorship of research in otolaryngology was limited to a small number of surgeons. In addition, otolaryngologists generally received less research payment than other surgeons. These findings are consistent with prior work examining nonresearch payments to otolaryngologists and suggest less potential for bias in the literature and practice of otolaryngology.4
Given formidable competition for federal funding to investigate otolaryngologic diseases,5 the health care industry may serve as an important resource for otolaryngologists. At present, our findings indicate that industry funding is concentrated among a subset of top earners funded by manufacturers with products indicated for sinonasal and otologic conditions. Patients may benefit from more diverse collaborations between otolaryngologists and the health care industry, particularly in emerging disciplines such as sleep medicine and laryngology.6
This study has limitations. It is certain that the findings underestimate the extent of industry support, as manufacturers are permitted to delay the publication of research payments related to products under development or novel applications of existing products. In addition, analyses provide limited context to understand the nature of research activities. Additional investigation is necessary to understand the promise and pitfalls of industry collaborations in otolaryngology.
Corresponding Author: Vinay K. Rathi, MD, Massachusetts Eye & Ear Infirmary, 243 Charles St, Boston, MA 02114 (email@example.com).
Accepted for Publication: January 8, 2017.
Published Online: April 6, 2017. doi:10.1001/jamaoto.2017.0002
Author Contributions: Dr Abt had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Rathi and Abt contributed to this work equally. The authors assume full responsibility for the accuracy and completeness of the ideas presented.
Concept and design: Rathi, Abt, Gray.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Rathi, Abt.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Rathi, Abt.
Administrative, technical, or material support: Abt, Kozin, Gray.
Supervision: Kozin, Naunheim, Gray.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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