Drug companies have long known that even small gifts to physicians
can be influential, and research validates the notion that they tend to
induce feelings of reciprocity.
A majority of patients in the United States visited a doctor who
received payments from drug companies, but most have no clue about it,
according to a new Drexel University study.
‘A majority of patients in the United States visited a doctor who received payments from drug companies, but most have no clue about it.’
About 65% of those surveyed as a part of the study by
Genevieve Pham-Kanter, an assistant professor in Drexel's Dornsife
School of Public Health, visited a doctor within the last year who had
received payments or gifts from pharmaceutical or medical device
companies. What's more: Only 5% of those surveyed knew that their
doctor had received such payments.
"These findings tell us that if you thought that your doctor was not
receiving any money from industry, you're most likely mistaken,"
Pham-Kanter said. "Patients should be aware of the incentives that their
physicians face that may lead them to not always act in their patients'
best interest. And the more informed patients are about their providers
and options for care, the better decisions they can make."
Pham-Kanter's study, published in the Journal of General Internal Medicine
and done jointly with collaborators at Stanford and Harvard
universities, was funded by the Greenwall Foundation. The study's
investigators conducted a nationally representative survey of more than
3,500 adults and linked their doctors to data from Open Payments, a
government website that reports pharmaceutical and device industry
payments to physicians.
Open Payments was set up as part of the Physician Payment Sunshine
Act, a provision of the Affordable Care Act (Obamacare), in the effort
to make industry payment information publicly available and transparent.
Pham-Kanter's survey was conducted in September and October 2014,
shortly before Open Payments first began releasing data.
However, payment data were already available in "Sunshine" states
like Minnesota, Massachusetts and Vermont, on the journalism site Pro
Publica, and through disclosures made by pharmaceutical and medical
device firms themselves (who had been required to release payment
information as a part of legal settlements or did so voluntarily).
Although two-thirds of all patients visited doctors who had received
payments, those who visited certain types of specialists were even more
likely to have seen a doctor who had been paid. For example, 85%
of patients who visited an orthopedic surgeon saw a doctor who had
received payments, and 77% of those who visited an obstetrician
or gynecologist saw a doctor who had received payments.
The amount received by physicians varied greatly, but the
differences didn't give the appearance of being random. In Open
Payments, all physicians averaged $193 in payments and gifts. But when
measuring only the doctors visited by participants in the survey, the
median payment amount over the last year was $510, more than
two-and-a-half times the U.S. average.
"We may be lulled into thinking this isn't a big deal because the
average payment amount across all doctors is low," Pham-Kanter said.
"But that obscures the fact that most people are seeing doctors who
receive the largest payments."
With so few people even knowing that information on their doctors
and payments is available - just 12% in the study - it's
interesting to note the differences in who does seem to know about them.
In the three Sunshine states - where transparent doctor payment
information has been available for some time - people were about half
as likely to see physicians who'd received payments as patients in other
states (34% to 66%). The authors surmised that even if
patients don't know about the information, physicians could be more
likely to shy away from taking industry payments if they know the
information is public.
"Transparency can act as a deterrent for doctors to refrain from
behaviors that reflect badly on them and are also not good for their
patients," Pham-Kanter said.
But why are so few people aware of payment information?
"Some of it may be related to how easy or difficult it is to access this information," Pham-Kanter said.
For that reason, Pham-Kanter and her research team feel that it's
integral to bring payment numbers forward to places where people already
seek information about their doctors, particularly on digital
However, since Open Payments is a part of the Affordable Care Act,
and the law's future is currently in limbo due to a potential
Congressional repeal, there is concern over whether transparently
tracking industry payments will continue.
"If the Sunshine Act, as part of the Affordable Care Act, is
repealed, it will certainly move us backwards," Pham-Kanter said. "There
has been a lot of useful information - for patients, policymakers and
researchers - that has come out about the scope and scale of these
payments and how they might influence doctors, and I'm sure there's much
more to learn."