Researchers at Memorial Sloan Kettering Cancer Center (MSK), led by Aaron Mitchell, MD, MPH, a medical oncologist and health services researcher in the Department of Epidemiology and Biostatistics, have published the first systemic review of the association between industry payments and physician prescribing in order to determine whether evidence is sufficient to conclude that payments cause physicians to change their prescribing practices across a broad range of medical specialties and drug types.
Financial payments from the drug industry to U.S. physicians are common. From 2015 to 2017, 67% of all U.S. physicians received payments. Beginning in 2013, the Open Payments reporting system created by the Physician Payments Sunshine Act has made public all ﬁnancial transfers greater than $10 in value from drug and device manufacturers to U.S. physicians and several other provider groups. Open Payments has enabled large-scale, quantitative investigation into the ﬁnancial component of physician–industry interactions. Since then, numerous studies have used Open Payments data to assess whether industry payments inﬂuence physician prescribing.
Despite recent studies assessing industry payments across a broad range of medical specialties and drug classes, no consensus exists on the overall association between industry payments and physician prescribing or on whether such an association is causal.
In work published by the Annals of Internal Medicine, Dr. Mitchell and colleagues reviewed a total of 36 studies that estimated the association between receipt of industry payments (exposure) and prescribing (outcome). Thirty of the studies identified a positive association between payments and prescribing in all analyses; the remainder had a mix of positive and null ﬁndings. Of 101 individual analyses, 89 identiﬁed a positive association. Payments were associated with increased prescribing of the paying company’s drug, increased prescribing costs, and increased prescribing of branded drugs.
Prior work has established that interaction with the drug industry inﬂuences physician formulary recommendations, clinical research, and clinical practice guideline recommendation. Studies reporting on the distribution of industry payments consistently found that food and beverage payments were the most common and that compensation payments, honoraria, and consulting fees were less common but of greater dollar value.
“We present evidence that receipt of ﬁnancial payments from industry is consistently associated with increased prescribing. This association has been identiﬁed across a broad range of physician specialties, drug classes, and prescribing decisions,” explained Dr. Mitchell. “Despite longstanding concerns about the potential for industry inﬂuence on medical practice, industry payments to physicians remain common. We think the strength of these findings can help bring clarity and advance discussion on this important topic.”