Conflicts of interest: physicians, pharma, and overuse

Nobody likes hearing about doctors taking industry kickbacks though there is evidence of it everywhere. Last year, for example, a Lown Institute overuse report found that physicians performing back surgery overuse received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, over three years.

Several recent studies show that these conflicts of interest are deeply entrenched in modern medicine and that existing regulations are doing little to rein in the problem.

Pharma payments tied to more prescribing

A report from Conflixis, a healthcare analytics platform, looks at industry payments and prescribing patterns for four name brand drugs: chronic obstructive pulmonary disease inhalant Trelegy, diabetes therapy Farxiga, gout medication Krystexxa, and weight-loss shot Ozempic. 

As reported in Politico, Conflixis shows that providers who received payments from Ozempic-maker Novo Nordisk—in the form of free meals, industry-funded continuing-education events and other perks—prescribe the medication 2.7 times more frequently than doctors who weren’t gifted these perks. The result: an eye-popping $3.7 billion in prescriptions.

Lown Institute president Vikas Saini notes in this article, “There’s nothing wrong with device manufacturers or the pharma industry wanting to get its products into commerce.” The real problem, he argues, is the lack of oversight: it’s unclear whether the additional prescriptions reflect genuine patient need—and no entity is tracking that appropriateness.

“The [medical] profession itself needs to create an infrastructure for auditing and monitoring feedback on appropriateness.”

Dr. Vikas Saini, Lown Institute president, in Politico

Physicians recognize problematic conflicts

Physicians themselves are clamoring for changes that would address these conflicts of interest. A study in JAMA Health Forum which digs into physicians’ own perspectives on pharmaceutical promotions shows that, as they progress through their careers, support for guardrails and transparency grew.

The respondents were first surveyed in 2011 as medical students or residents and then again in 2024. The data show that, over time, physicians:

• Were more likely to strongly agree that trust in medicine was threatened by industry marketing interactions (5.6% in 2011 vs 14.5% in 2024). 
• Showed increased agreement that medical schools should not permit interactions between industry and students in training facilities (59.6% in 2011 vs 72.2% in 2024)
• Showed increased agreement that schools should require faculty to disclose conflicts of interest before lectures (88.9% in 2011 vs 99.7% in 2024)

Yet some contradictions remain. In 2024, more respondents agreed that marketing provides useful information to physicians (76.9%, up from 66.3% in 2011), and more also supported accepting gifts under $50 from pharmaceutical representatives.

Medical schools let conflicts slide

This mutualistic pharma/provider relationship extends even into academia. Pharmaceutical companies commonly recruit and pay clinicians, often key opinion leaders in their field, to serve on Industry-sponsored speakers’ bureaus (ISSBs) to give educational presentations promoting company products.

A recent JAMA Network Open study shows that many medical schools still lack clear policies addressing this practice. Of the conflict of interest policies studied:

• 38% explicitly prohibited ISSBs
• 19% prohibited ISSBs with exceptions or permitted ISSBs with conditions, 
• 9% discouraged ISSBs without conditions
• 13% explicitly permitted ISSBs
• 21% did not address ISSBs

This failure to clearly address and bar faculty from serving as industry spokespersons “relinquish(es) substantial control of the educational content to the pharmaceutical company,” notes the study. 

Join the Discussion

On October 7, the Lown Institute shines the spotlight on conflicts of interest and medical overuse with a new report about unnecessary spinal surgeries which cost our health system billions and place tens of thousands of Americans at risk of harm. We hope you’ll join us for an interactive discussion about this report with Lown Institute President Dr. Vikas Saini and leading overuse experts.