More than half of doctors receive industry payments, with some making millions

A recent study in JAMA finds that 57% of physicians received a payment from pharmaceutical or medical device companies over the past ten years. What are the implications of these industry payments?

Millions in payments

The authors of the JAMA study examined industry payments to physicians through CMS’ Open Payments portal (you can use this tool to look up your doctor!), looking at payments made between 2013 and 2022, not including research grants. In total, drug and device companies paid about $12 billion to more than 800,000 physicians during this time period.

Industry payments were widespread, but also varied considerably. The median payment for doctors was $48, but some doctors were paid in the millions. For example, the average amount paid to the top 0.1% of orthopedic surgeons was over $4.8 million.

The largest payments were associated with Xarelto and Eliquis, two popular blood thinners (which may be subject to Medicare price negotiation in upcoming years) and robotic surgical systems on the medical device side.

Why should we care?

Does it matter that drug and device manufacturers are paying doctors for things like food and beverages, travel, speaker fees, or gifts? What harm could just a $48 free lunch do?

While it may seem innocuous, studies have shown that industry-sponsored meals worth just $20 are associated with increased rates of prescribing brand name medications. A 2018 analysis found that doctors who prescribed more opioids were more likely to receive money from a pharmaceutical company than doctors who prescribed the median amount. And payments to doctors from medical device companies have been shown to influence which device cardiologists choose to implant for patients with heart failure.

There are other impacts of industry payments beyond doctors’ prescribing decisions. For doctors that hold positions on panels and other decision-making bodies, conflicts of interest could influence medical guidelines and policy. For example, most of the doctors on an FDA advisory panel formed to assess a cardiac device made by Abbott had received payments from Abbott or conducted research sponsored by the company, KFF Health News reported. A 2019 study also found that 42% of medical journal editors receive industry payments annually, with the average payment more than $55,000.

Where do we go from here?

The transparency that OpenPayments provides is incredibly valuable, but it’s just the first step in tackling financial conflicts of interest. Few patients have looked up their doctor to find out whether they are receiving payments. And as the Abbott panel story shows, government bodies may not take into account whether doctors have conflicts when they create advisory groups.

To combat this problem, there should be more stringent rules regarding industry relationships for doctors in leadership positions on panels or advisory groups, especially groups evaluating a specific product. More broadly, the government could consider limits on dollar amounts for general payments or a ban on lucrative “speaker deals,” which some government officials have warned as ripe for fraud.