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Noor MN, Abbasi HS, van Der Mark N, Azizullah Z, Linton J, Rahman-Shepherd A, Siddiqui AR, Khan MS, Hasan R, Shakoor S. Healthcare consumers' perceptions of incentive-linked prescribing: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003026. [PMID: 38935777 PMCID: PMC11210849 DOI: 10.1371/journal.pgph.0003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024]
Abstract
Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients' health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and the general public often have far less awareness about the practice of pharmaceutical incentivisation of physicians. We conducted a scoping review to explore what existing research says about HCCs' perceptions of the financial relationship between physicians and pharmaceutical companies. To conduct this scoping review, we followed Arksey and O'Malley's five-stage framework: identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results. We also used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews (PRISMA-ScR), as a guide to organise the information in this review. Quantitative and qualitative studies with patients and the general public, published in the English language were identified through searches of Scopus, Medline (OVID), EMBASE (OVID), and Google Scholar. Three themes emerged through the analysis of the 13 eligible studies: understanding of incentivisation, perceptions of hazards linked to ILP, and HCCs' suggestions to address it. We found documentation that HCCs exhibited a range of knowledge from good to insufficient about the pharmaceutical incentivisation of physicians. HCCs perceived several hazards linked to ILP such as a lack of trust in physicians and the healthcare system, the prescribing of unnecessary medications, and the negative effect on physicians' reputations in society. In addition to strong regulatory controls, it is critical that physicians self-regulate their behaviour, and publicly disclose if they have any financial ties with pharmaceutical companies. Doing so can contribute to trust between patients and physicians, an important part of patient-focused care and a contributor to user confidence in the wider health system.
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Affiliation(s)
- Muhammad Naveed Noor
- Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Haider Safdar Abbasi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Nina van Der Mark
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zahida Azizullah
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Mishal Sameer Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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2
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Midtlien JP, Iyer AM, Jones BS, Kittel C, Hirsch JA, Fargen KM. Conflicts of interest and neurointerventional surgery. J Neurointerv Surg 2024; 16:537-540. [PMID: 37491382 DOI: 10.1136/jnis-2023-020646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Jackson P Midtlien
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ankitha M Iyer
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brie S Jones
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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3
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Sayed A, Ross JS, Mandrola J, Lehmann LS, Foy AJ. Industry Payments to US Physicians by Specialty and Product Type. JAMA 2024; 331:1325-1327. [PMID: 38546577 PMCID: PMC10979352 DOI: 10.1001/jama.2024.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/07/2024] [Indexed: 04/01/2024]
Abstract
This study examines the distribution of payments within and across specialties and the medical products associated with the largest total payments.
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Affiliation(s)
- Ahmed Sayed
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Andrew J. Foy
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Choudhry HS, Choudhry HS, Burton C, Patel AM, Patel R, Li X, Berkowitz S, Kaleem MA. Characterizing industry payments to ophthalmologists before and after onset of the COVID-19 pandemic. RESEARCH SQUARE 2023:rs.3.rs-3329175. [PMID: 37790499 PMCID: PMC10543250 DOI: 10.21203/rs.3.rs-3329175/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Purpose The COVID-19 pandemic had profound effects on many different aspects of our healthcare system and the relationship between industry and physicians was no exception. The present database study evaluates industry payments to ophthalmologists in order to identify whether there are significant differences in industry payments to ophthalmologists before and after onset of the pandemic. Methods The Centers for Medicare & Medicaid Services Open Payments Database was queried for all ophthalmologists who received industry payments between 2018 and 2021. Pre-Covid was defined as 2018-2019 while post-Covid was defined as 2020-2021. Payment date, value, type, company making payment, and state of recipient were recorded. The top ten companies and states in terms of payment value were included in analysis. Generalized Estimating Equations (GEE) modeling was used to assess significance. Results There were 729,263 industry payments to 20,832 ophthalmologists totaling $817,892,867.54 included for analysis in this study. We found that there was a significant increase in the mean value of research payments and a significant decrease in the mean value of general payments after the onset of the pandemic (both p < 0.001). We also report significant changes in industry payments to ophthalmologists based on the company making the payment and the state in which the ophthalmologist practices. Conclusions Our results suggest that significant differences exist in industry payment patterns to ophthalmologists following onset of the COVID-19 pandemic. Understanding underlying reasons for the observed differences may improve our understanding of the relationship between industry and clinical ophthalmology.
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Affiliation(s)
| | | | | | | | | | - Ximin Li
- Johns Hopkins School of Public Health
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5
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Khan M, Rahman-Shepherd A, Noor MN, Sharif S, Hamid M, Aftab W, Isani AK, Khan RI, Hasan R, Shakoor S, Siddiqi S. Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001890. [PMID: 37384598 DOI: 10.1371/journal.pgph.0001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/12/2023] [Indexed: 07/01/2023]
Abstract
Focus on profit-generating enterprise in healthcare can create conflicts of interest that adversely impact prescribing and pricing of medicines. Although a global challenge, addressing the impacts on quality of care is particularly difficult in countries where the pharmaceutical industry and physician lobby is strong relative to regulatory institutions. Our study characterises the range of incentives exchanged between the pharmaceutical industry and physicians, and investigates the differences between incentivisation practices and policies in Pakistan. In this mixed methods study, we first thematically analysed semi-structured interviews with 28 purposively selected for-profit primary-care physicians and 13 medical sales representatives from pharmaceutical companies working across Pakistan's largest city, Karachi. We then conducted a content analysis of policies on ethical practice issued by two regulatory bodies responsible in Pakistan, and the World Health Organization. This enabled a systematic comparison of incentivisation practices with what is considered 'prohibitive' or 'permissive' in policy. Our findings demonstrate that incentivisation of physicians to meet pharmaceutical sales targets is the norm, and that both parties play in the symbiotic physician-pharma incentivisation dynamics. Further, we were able to categorise the types of incentive exchanged into one of five categories: financial, material, professional or educational, social or recreational, and familial. Our comparison of incentivisation practices with policies revealed three reasons for such widespread incentivisation linked to sales targets: first, some clear policies were being ignored by physicians; second, there are ambiguous or contradictory policies with respect to specific incentive types; and third, numerous incentive types are unaddressed by existing policies, such as pharmaceutical companies paying for private clinic renovations. There is a need for policies to be clarified and updated, and to build buy-in for policy enforcement from pharmaceutical companies and physicians, such that transgressions on target-driven prescribing are seen to be unethical.
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Affiliation(s)
- Mishal Khan
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sabeen Sharif
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Meherunissa Hamid
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wafa Aftab
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Ying X, Rosenblatt R, Fortune BE. Trends in Industry Payments to Gastroenterologists and Hepatologists in the United States From 2014 to 2020. Gastroenterology 2022; 163:787-791. [PMID: 35714706 DOI: 10.1053/j.gastro.2022.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Xiaohan Ying
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Brett E Fortune
- Division of Hepatology, Montefiore-Albert Einstein College of Medicine, Bronx, New York
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Casciato DJ, Mendicino RW. CMS Open Payments Database Analysis of Industry Payments for Foot and Ankle Surgery Research. J Foot Ankle Surg 2022; 61:1013-1016. [PMID: 35172954 DOI: 10.1053/j.jfas.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/30/2021] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
With decreasing federal funding, the role of industry in supporting medical investigations continues to grow. To increase transparency between physicians and industry, the Centers for Medicare and Medicaid Services introduced the Open Payments Program, providing a searchable database of physician payments from entities including medical device companies. This study describes industry research payments and trends among foot and ankle surgeons. Research Payment Data among foot and ankle surgeons from the Open Payments Database was reviewed from 2013 through 2020. Payment year, value, type, and physician name were collected, and descriptive statistics were presented. Linear regression assessed trends in the number and value of payments. Analysis of variance and subsequent post hoc testing assessed differences in mean payment value. A p value of ≤.05 was considered statistically significant. Overall, 10,872 payments totaling $69,595,393.10 among 446 foot and ankle surgeons were analyzed. No statistically significant increase in number of physicians, payments, or mean payment value per physician was observed from 2013 through 2020. However, the average value of payments in 2019 and 2020 was greater than 2015 and 2017 (p ≤ .05). The top 50 physicians according to cumulative payment value received $54,696,623.10 with 9427 (86.7%) cash and cash-equivalent payments representing the most common payment type overall. Industry continues to provide financial support to foot and ankle surgery research. Results of this investigation spur future studies to examine the relationship between payments and positive results reported by lead investigators in published research.
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Chen X. Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space. HEALTH CARE ANALYSIS 2021; 30:35-56. [PMID: 34761311 PMCID: PMC8580741 DOI: 10.1007/s10728-021-00438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies.
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Affiliation(s)
- Xiaoying Chen
- School of Humanities, Southeast University, 2 Southeast University Road, Jiangning District, Nanjing, 211189, People's Republic of China.
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Mawn JG, Amin RM, Harrell J, Runge N, Hollifield L, Lopez J, Khanuja HS, Sterling RS, Oni JK. Perceptions of Financial Conflict of Interest and Knowledge of the Sunshine Act Among Orthopedic Surgery Patients. Orthopedics 2021; 44:e682-e686. [PMID: 34590959 DOI: 10.3928/01477447-20210818-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The orthopedic surgical specialty is strongly tied to partnerships with industry that have fostered innovation and greatly enhanced patient care. A substantial number of orthopedic surgeons currently receive some form of industry support. These relationships are highly scrutinized because they present the possibility of both personal and financial conflicts of interest (COI). The authors examined orthopedic patients' awareness of existing regulation and perceptions of financial COI by performing a prospective survey-based study of patients seen in an academic orthopedic department. Data were collected during 1 year, in a cross-section of hospital-based and community clinical settings. The authors collected 513 surveys during a 1-year period between 4 clinical locations. Of all respondents, 55% were unconcerned regarding gifts or direct compensation their physicians received from industry, and only 16% were very or extremely concerned regarding these benefits. Patients' opinions regarding possible influence of benefits were similarly ambivalent, with 54% of patients minimally or not at all concerned regarding the potential influence of industry gifts or compensation. Seventy-six percent of patients had never heard of the Sunshine Act, and only 3% indicated that they were aware of the legislation and its intention. The income of the respondents and their level of education were positively correlated with increased concern about handling of COI, as well as knowledge regarding the Sunshine Act. These data suggest that orthopedic surgery patients are widely unconcerned regarding physician COI, but specific subsets of patients may be more likely to have concerns regarding these relationships. [Orthopedics. 2021;44(5):e682-e686.].
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Lexchin J, Fugh-Berman A. A Ray of Sunshine: Transparency in Physician-Industry Relationships Is Not Enough. J Gen Intern Med 2021; 36:3194-3198. [PMID: 33694070 PMCID: PMC8481515 DOI: 10.1007/s11606-021-06657-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
Gifts from pharmaceutical and medical device companies to physicians in the United States have been reported since 2014, through the Physician Payments Sunshine Act. Although researchers have utilized these data to publish many studies on conflicts of interest (COIs) and prescribing behavior, there is no evidence that physician behavior regarding COI has changed, or that employers, meeting organizers, or medical journals are excluding physicians based on conflicts of interest. Disclosure is necessary but not sufficient to address the damage that industry relationships causes to medical knowledge and public health.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON Canada
- University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Adriane Fugh-Berman
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC USA
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Patient responses to physician disclosures of industry conflicts of interest: A randomized field experiment. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2021. [DOI: 10.1016/j.obhdp.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Kolarich AR, Pang S, Solomon AJ, England RW, Georgiades C. Increasing Consulting Fee Payments to Interventional Radiologists in the United States From Industry, 2014 to 2018: Analysis of the Open Payments Database. J Am Coll Radiol 2021; 18:1668-1674. [PMID: 34418340 DOI: 10.1016/j.jacr.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate trends in consulting fees from industry to US-based interventional radiologists from 2014 to 2018. METHODS Payments to interventional radiologists from January 1, 2014, to December 31, 2018, were analyzed from the CMS Open Payments Database. Payment type, total consulting fee payments per year and total payment per physician, and aggregate payments per company were analyzed before and after adjustment for outliers. RESULTS Over the 5-year period, a total of $79.8 million was paid from industry to interventional radiologists, of which $17.6 million (22.1%) represented consulting fees. Per physician, the median total yearly amount paid as consulting fees was $5,050. Consulting fees increased from a total of $2.8 million per year in 2014 to $4.6 million per year in 2018 (+65%). After adjustment for outliers, consulting fee payments rose from $1.8 million to $3.5 million (+94%). The number of physicians paid each year increased from 156 to 219 physicians and the median payment increased from $4,327 to $5,419. Before ($5,118,966) and after adjustment, Sirtex Medical Inc paid the highest total aggregate consulting fee payments per year to self-identified interventional radiologists. After expansion to include both interventional and diagnostic radiologists by specialty type, Merck Sharp & Dohme Corp ($21,505,861) and Pfizer Inc ($11,798,255) followed by Sirtex Medical Inc ($8,276,818) paid the highest total aggregate in consulting fees. CONCLUSION Total consulting fees to interventional radiologists increased between 2014 and 2018 by 65%, driven by both the increased number of physicians paid consulting fees and the increased average payment amount.
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Affiliation(s)
- Andrew R Kolarich
- Diagnostic and Interventional Radiology Resident, Johns Hopkins Hospital Publications Committee, Society of Interventional Oncology, Radiology Residency Co-Director of Research, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sharon Pang
- Medical Student, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alex J Solomon
- Chief Resident, Interventional Radiology (IR/DR) Residency, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Deputy Editor, Radiology-in-Training 2020-2021; and Publications Committee, Society of Interventional Oncology
| | - Ryan W England
- Diagnostic and Interventional Radiology Resident, Johns Hopkins Hospital, Baltimore, Maryland; Associate Editor, Radiology-In-Training, 2021-2022; and Radiology Residency Co-Director of Research, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christos Georgiades
- Director, Interventional Oncology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Chair, Publications Committee, Society of Interventional Oncology; and Associate Editor, Radiology, Journal of the Radiological Society of North America
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13
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Partan MJ, White PB, Frane N, Iturriaga CR, Bitterman A. The Influence of the Sunshine Act on Industry Payments to United States Orthopaedic Sports Medicine Surgeons. Arthroscopy 2021; 37:1929-1936. [PMID: 33677022 DOI: 10.1016/j.arthro.2021.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the present study is to investigate trends in overall payments to orthopaedic sports medicine surgeons reported by the Open Payments Database (OPD) over the 6 full years of available data (2014-2019). METHODS A retrospective review of industry payments to United States sports medicine trained orthopaedic surgeons from 2014 to 2019 was performed using the Centers for Medicare and Medicaid Services OPD. Total payments and subtype payments were analyzed for yearly trends. Regional analysis was also performed. The primary outcome was the overall trend in total median payments (defined as the median total payments per surgeon per year), which was assessed via the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P values < .05 were considered statistically significant. RESULTS From 2014 to 2019, there were a total of 1,941,772 payments to 12,816 sports medicine orthopaedic surgeons. The median payments to surgeons demonstrated a significant upward trend (P < .001). The total number of payments (r = 0.002; P = .99) did not significantly correlate with changing year. The top 5 compensated surgeons received 45.8% of all industry contributions with a median total payment of $9,210,974.06 (interquartile range: 25,029,951.46). The majority of industry contributions in the top 5 earners were attributed to royalties and licenses (98.7%). Across the study period, 89.4% of the total orthopaedic sports medicine surgeons received a yearly total payment less than $10,000, which made up 8.3% of the total industry payment sum. Those receiving a yearly total payment greater than $500,000 accounted for 0.3% of surgeons but received 53.4% of the sum payments. We found a yearly increasing trend in payments in all regions including the Midwest, South, Northeast, and West (P < .001, P < .001, P < .001, and P = .006). CONCLUSION Despite the transparency of reporting mandated by the Sunshine Act, orthopaedic sports medicine surgeons have continued to maintain industry relationships with a notable disparity in distribution. CLINICAL SIGNIFICANCE Our analysis suggests continued relationships among sports medicine surgeons and industry. Future research is needed to determine how this impacts medical practice in the United States.
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Affiliation(s)
- Matthew J Partan
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A..
| | - Peter B White
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Nicholas Frane
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Cesar R Iturriaga
- Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
| | - Adam Bitterman
- Zucker School of Medicine at Hofstra/Northwell Orthopaedic Surgery Residency Program, Plainview, New York; Northwell Health Huntington Hospital, Department of Orthopaedic Surgery, Huntington, New York, U.S.A
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Thompson R, Paskins Z, Main BG, Pope TM, Chan ECY, Moulton BW, Barry MJ, Braddock CH. Addressing Conflicts of Interest in Health and Medicine: Current Evidence and Implications for Patient Decision Aid Development. Med Decis Making 2021; 41:768-779. [PMID: 33966538 DOI: 10.1177/0272989x211008881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND More stringent policies for addressing conflicts of interest have been implemented around the world in recent years. Considering the value of revisiting conflict of interest quality standards set by the International Patient Decision Aid Standards (IPDAS) Collaboration, we sought to review evidence relevant to 2 questions: 1) What are the effects of different strategies for managing conflicts of interest? and 2) What are patients' perspectives on conflicts of interest? METHODS We conducted a narrative review of English-language articles and abstracts from 2010 to 2019 that reported relevant quantitative or qualitative research. RESULTS Of 1743 articles and 118 abstracts identified, 41 articles and 2 abstracts were included. Most evidence on the effects of conflict of interest management strategies pertained only to subsequent compliance with the management strategy. This evidence highlighted substantial noncompliance with prevailing requirements. Evidence on patient perspectives on conflicts of interest offered several insights, including the existence of diverse views on the acceptability of conflicts of interest, the salience of conflict of interest type and monetary value to patients, and the possibility that conflict of interest disclosure could have unintended effects. We identified no published research on the effects of IPDAS Collaboration conflict of interest quality standards on patient decision making or outcomes. LIMITATIONS Because we did not conduct a systematic review, we may have missed some evidence relevant to our review questions. In addition, our team did not include patient partners. CONCLUSIONS The findings of this review have implications for the management of conflicts of interest not only in patient decision aid development but also in clinical practice guideline development, health and medical research reporting, and health care delivery.
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Affiliation(s)
- Rachel Thompson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, Staffordshire, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, UK
| | - Barry G Main
- Centre for Surgical Research and National Institute for Health Research Bristol Biomedical Research Centre, School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | | | - Clarence H Braddock
- Deans Office, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
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15
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Review of Industry Payments to General Orthopaedic Surgeons Reported by the Open Payments Database: 2014 to 2019. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e21.00060. [PMID: 33974570 PMCID: PMC8116034 DOI: 10.5435/jaaosglobal-d-21-00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Introduction: The Physician Payments Sunshine Act was placed into law in 2010 in an effort to create transparency between physicians and industry. Along with many other specialties, orthopaedic surgeons have long worked intimately with medical industry companies. This study aimed to evaluate trends in industry payments to general orthopaedic surgeons from 2014 to 2019. Methods: A retrospective review of the Center of Medicare and Medicaid Services' Open Payments Database was done to identify all industry payments to all general orthopaedic surgeons (ie, not subspecialty affiliated) from 2014 to 2019. The researchers analyzed total payments and subtype payments for yearly trends, and a regional analysis was done. The primary outcome was the overall trend in total median payments, which was assessed through the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P < 0.05 was considered statistically significant. Results: Between 2014 and 2019, a total of 1,330,543 payments totaling $1.79 billion dollars was paid to 108,041 general orthopaedic surgeons. During this time, the number of surgeons receiving payments increased with a significant uptrend in median payments per surgeon (P < 0.001; Table 1). The top 25% percentile of general orthopaedic surgeons received >95% of payments, whereas the bottom 25% received <0.1%. The general payment types all saw significant increases (P < 0.001) between 2014 and 2019, with the exception of “Ownership or Investment Interests” (P = 0.657) and “Royalty or License” (P = 0.517). Significant regional uptrends in median industry payments were also seen in the Midwest, Northeast, South, and West (P < 0.001). Four of the top five orthopaedic industry companies made payment increases between 2014 and 2019. Conclusion: Industry payments to general orthopaedic surgeons between 2014 and 2019 have increased with a considerable disparity in payments among the top-paid orthopaedic surgeons.
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Effron DA, Raj M. Disclosing interpersonal conflicts of interest: Revealing whom we like, but not whom we dislike. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2021. [DOI: 10.1016/j.obhdp.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Schultz É, Ward JK, Atlani-Duault L, Holmes SM, Mancini J. French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052611. [PMID: 33807787 PMCID: PMC7967331 DOI: 10.3390/ijerph18052611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic put clinical research in the media spotlight globally. This article proposes a first measure of familiarity with and attitude toward clinical research in France. Drawing from the “Health Literacy Survey 2019” (HLS19) conducted online between 27 May and 5 June 2020 on a sample of the French adult population (N = 1003), we show that a significant proportion of the French population claimed some familiarity with clinical trials (64.8%) and had positive attitudes (72%) toward them. One of the important findings of this study is that positive attitudes toward clinical research exist side by side with a strong distancing from the pharmaceutical industry. While respondents acknowledged that the pharmaceutical industry plays an important role in clinical research (68.3%), only one-quarter indicated that they trust the industry (25.7%). Positive attitudes toward clinical trials were associated with familiarity with clinical trials (Odds Ratio, OR 2.97 [1.90–4.63]), financial difficulties (OR 0.63 [0.46–0.85]), as well as mistrust of doctors (0.48 [0.27–0.85]) and of scientists (OR 0.62 [0.38–0.99]). Although the French media provided a great deal of information on how clinical research works during the first months of the pandemic, there remains profound mistrust of the pharmaceutical industry in France. This suspicion can undermine crisis management, especially in the areas of vaccine development and preparation for future pandemics.
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Affiliation(s)
- Émilien Schultz
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Correspondence:
| | - Jeremy K. Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94801 Villejuif, France;
- VITROME, Aix-Marseille University, IRD, AP-HM, SSA, 13005 Marseille, France
| | - Laëtitia Atlani-Duault
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- Institut COVID-19 Add Memoriam, University of Paris, 75006 Paris, France
- WHO Collaborative Center for Research on Health and Humanitarian Policies and Practices, IRD, Université de Paris, 75006 Paris, France
| | - Seth M. Holmes
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Society and Environment, Medical Anthropology, and Public Health, University of Berkeley, Berkeley, CA 94720, USA
- Mediterranean Institute for Advanced Study IMéRA, Institut Paoli Calmettes, Aix-Marseille University, 13004 Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- BioSTIC, APHM, Timone, 13005 Marseille, France
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Tarras ES, Marshall DC, Rosenzweig K, Korenstein D, Chimonas S. Trends in Industry Payments to Medical Oncologists in the United States Since the Inception of the Open Payments Program, 2014 to 2019. JAMA Oncol 2021; 7:440-444. [PMID: 33377904 DOI: 10.1001/jamaoncol.2020.6591] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Given the potential for undue influence of industry-physician payments on oncology care, it is important to understand how a national transparency program may be associated with financial interactions between industry and medical oncologists. Objective To identify trends in industry payments to medical oncologists from 2014 to 2019 and determine if the implementation of the Open Payments program is associated with changes in the frequency or value of payments or any shift in the nature of industry-oncologist financial interactions. Design, Setting, and Participants This retrospective, population-based, observational cohort study analyzed Open Payments reports of industry payments made in 2014 to 2019 to a cohort of licensed medical oncologists practicing in the US in 2014, using data from the National Plan and Provider Enumeration System. Exposures Receipt of an industry payment from January 1, 2014, to December 31, 2019. Main Outcomes and Measures General industry payments to medical oncologists, including the proportion receiving payments, total annual value and number of payments, and average annual trends over time, by aggregate value and by nature-of-payment category. Trends over time were analyzed using linear regression and generalized estimating equations. Results In 2014 to 2019, there were 15 585 medical oncologists who received a total of 2.2 million industry payments with a total value of $509 million. The absolute number of oncologists receiving payments decreased from 10 498 in 2014 to 8918 in 2019 (-15.1%). The annual per-physician payment value decreased among those receiving less than $10 000 in aggregate by -3.2% yearly (95% CI, -4.1% to -2.3%; P < .001), but increased for those receiving more than $10 000. Payments increased for consulting (13.7%; 95% CI, 12.4%-15.0%; P < .001) and for entertainment, meals, travel or lodging, and gifts (0.8%; 95% CI, 0.1%-1.5%; P = .03). Conclusions and Relevance The number of medical oncologists accepting industry payments has decreased; however, high-value industry payments have been consolidated in a relatively small number of medical oncologists accepting higher payment values over time. The nature of payments has shifted toward consulting. These findings highlight the limitations of transparency without accountability.
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Affiliation(s)
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, New York, New York
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Price SM, O'Donoghue AC, Rizzo L, Sapru S, Aikin KJ. What influences healthcare providers' prescribing decisions? Results from a national survey. Res Social Adm Pharm 2021; 17:1770-1779. [PMID: 33558154 DOI: 10.1016/j.sapharm.2021.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior U.S. Food and Drug Administration (FDA) surveys with healthcare providers (HCPs) have focused on attitudes toward direct-to-consumer advertising and have not specifically examined professionally-targeted prescription drug promotion. Similarly, there are no recent national surveys of HCPs examining their interactions with the pharmaceutical industry. OBJECTIVES The goal of this study was to use a national sample of HCPs to examine exposure to professionally-targeted prescription drug promotions and interactions with industry, and knowledge, attitudes and practices related to FDA approval of prescription drugs. METHODS An online national survey was conducted with 2000 HCPs representing primary care physicians (PCPs), specialists (SPs), physician assistants (PAs), and nurse practitioners (NPs). The sample was randomly drawn from WebMD's Medscape subscriber network, stratified by HCP group, and designed to yield target numbers of completed surveys in each group. Weights were computed to correct for unequal selection probabilities, differential response rates, and differential coverage and used to generalize completed surveys to a national population of PCPs, SPs, NPs, and PAs. RESULTS Exposure and attention to pharmaceutical promotions and contact with industry were significantly associated with reported increase in pharmaceutical industry influence on decisions about prescription drugs. SPs were significantly more likely to prescribe off-label and serve as opinion leaders for the pharmaceutical industry compared to other provider groups. CONCLUSIONS Findings indicate pharmaceutical promotions directed at HCPs occur in many forms and are disseminated through multiple channels. By using a nationally representative sample of HCPs, this study provides population-level estimates for exposure and attention to prescription drug promotion and contact with industry and evidence for their influence on prescriber decisions. Findings from this study will help to inform FDA of HCP responses to and impacts of prescription drug promotion.
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Katz MS, Anderson PF, Thompson MA, Salmi L, Freeman-Daily J, Utengen A, Dizon DS, Blotner C, Cooke DT, Sparacio D, Staley AC, Fisch MJ, Young C, Attai DJ. Organizing Online Health Content: Developing Hashtag Collections for Healthier Internet-Based People and Communities. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31251658 DOI: 10.1200/cci.18.00124] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twitter use has increased among patients with cancer, advocates, and oncology professionals. Hashtags, a form of metadata, can be used to share content, organize health information, and create virtual communities of interest. Cancer-specific hashtags modeled on a breast cancer community, #bcsm, led to the development of a structured set of hashtags called the cancer tag ontology. In this article, we review how these hashtags have worked with the aim of describing our experience from 2011 to 2017. We discuss useful guidelines for the development and maintenance of health-oriented communities on Twitter, including possible challenges to community sustainability and opportunities for future improvement and research.
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Affiliation(s)
| | | | | | - Liz Salmi
- Beth Israel Deaconess Medical Center, Boston, MA.,Brain Cancer Quality of Life Collaborative, Sacramento, CA
| | | | | | | | | | - David T Cooke
- University of California Davis Medical Center, Sacramento, CA
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Goldberg DS. Financial Conflicts of Interest are of Higher Ethical Priority than "Intellectual" Conflicts of Interest. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:217-227. [PMID: 32607925 DOI: 10.1007/s11673-020-09989-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.
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Affiliation(s)
- Daniel S Goldberg
- Core Faculty, Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Family Medicine (CU School of Medicine), University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Epidemiology (CO School of Public Health), University of Colorado, Anschutz Medical Campus, Fulginiti Pavilion - Room 205, 13080 E. 19th Avenue, CB B137, Aurora, CO, 80045, USA.
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Abstract
Background: Physicians should follow ethical principles in their relationships with industry and be mindful that such relationships—if they are perceived as conflicts of interest—can undermine trust in the patient-physician relationship. Methods: By identifying potential pitfalls and safeguards that can help prevent problems, this article focuses on ensuring that physician-industry relationships do not result in ethical transgressions or cause damage to doctor-patient relationships. Results: Patient trust in physicians can be undermined by the perception that a physician-investigator is operating in the best interest of the research rather than the best interest of the patient. Payments from the pharmaceutical industry to physician-investigators are transparent because of the Sunshine Act, and patients can easily determine if their personal physicians have received money from industry. Research subsidies from industry should represent fair market value for the work performed. Postmarketing trials with the primary goal of increasing familiarity with a drug and prescribing rates should be avoided. Medical societies play an important role in establishing standards for professional conduct. Conclusion: Ethically sound actions in physician relationships with industry should be guided by professional standards, medical society guidelines, and local institutional policies.
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Niforatos JD, Chaitoff A, Mercer MB, Yu PC, Rose SL. Association Between Public Trust and Provider Specialty Among Physicians With Financial Conflicts of Interest. Mayo Clin Proc 2019; 94:2467-2475. [PMID: 31806100 DOI: 10.1016/j.mayocp.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To characterize public perception of physicians' conflicts of interest (COIs) across medical and surgical specialties. PATIENTS AND METHODS A cross-sectional 6-arm randomized survey of a nonprobability sample from Amazon's Mechanical Turk occurred on December 11 to 16, 2018. Survey respondents were randomly assigned to vignettes that varied the physician specialty with COI. The primary outcome was mean difference in Mayer Trust, and the secondary outcome included the proportion who desire to discontinue care. RESULTS There were 1729 of 1920 respondents who completed the experiment (90.1% completion rate). Respondents were male (52.5%; n=907), white (71.4%; n=1234), and between the ages of 25 and 44 years (70.9%; n=1227). Mean ± SD Mayer Trust across the 6 specialties was 3.7±.60, with the only between-specialty differences observed for psychiatry compared with the other specialties (F=5.4; P<.001). The median dollar amount that would affect respondents' trust in a physician was $5000 (interquartile range, $100-$100,000). A total of 75.1% (n=1298) of respondents desired COI information, with 41.6% (n=720) discontinuing care. Age older than 34 years (adjusted odds ratio [aOR], 0.7; 95%, CI, 0.49-0.99; P=.047), nonwhite race (aOR, 1.3; 95% CI, 1.02-1.6; P=.03), educational attainment of 4 or more years of college (aOR, 1.31; 95% CI, 1.05-1.6; P=.016), and physician specialty as a psychiatrist (aOR, 1.5; 95% CI, 1.03-2.2; P=.034) were predictors for discontinuing care. CONCLUSION Public COI disclosure is a common method for managing financial conflicts. Although survey respondents were more likely to discontinue care with a physician with COI, they will act on this knowledge of COI differently depending on the specialty of the physician. The finding that psychiatry is an outlier may be a chance finding that warrants further confirmation. Continued efforts to ensure best practices for disclosure are required.
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Affiliation(s)
- Joshua D Niforatos
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, OH; Department of Emergency Medicine, The Johns Hopkins Hospital/The Johns Hopkins School of Medicine, Baltimore, MD
| | - Alexander Chaitoff
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, OH; Department of Internal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - Pei-Chun Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, OH
| | - Susannah L Rose
- Office of Patient Experience, Cleveland Clinic, OH; Office of Patient Experience, Center for Bioethics, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
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Conflict of interest disclosure as a reminder of professional norms: Clients first! ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2019. [DOI: 10.1016/j.obhdp.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Shaya B, Al Homsi N, Eid K, Haidar Z, Khalil A, Merheb K, Honein-Abou Haidar G, Akl EA. Factors associated with the public's trust in physicians in the context of the Lebanese healthcare system: a qualitative study. BMC Health Serv Res 2019; 19:525. [PMID: 31351485 PMCID: PMC6660947 DOI: 10.1186/s12913-019-4354-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/17/2019] [Indexed: 01/26/2023] Open
Abstract
Background The Lebanese public perceives the physician-patient relationship as flawed. The objectives of this study are to assess factors associated with the public’s trust in physicians in the context of the Lebanese healthcare system and to explore potential ways to enhance it. Methods We conducted a qualitative study based on a grounded theory methodology using semi-structured interviews with members of the Lebanese public (not restricted to patients). We selected participants through convenience and maximum variation sampling approaches. The constant comparative analysis resulted in a theoretical framework that describes the factors influencing trust in physicians. Results Participants trusted an experienced, up-to-date, graduate of a North American or Western European school, working in a reputable hospital, with a high level of diagnostic skills. The personal characteristics that improved trust were physicians who are ‘non-materialistic’, have a good rapport, and have sufficient encounter time with patients. Social factors that enhance trust in the physician include: being a family member, recommended by a family member, featured in mainstream media, and/or having a good reputation. Trust increased compliance, loyalty despite occasional mistakes committed, high consultation fees, and negative attitudes towards the physician’s institution. Conversely, no trust led to severed therapeutic relationship and seeking second opinions. Conclusion The level of trust of members of the Lebanese public in physicians was affected by the personal characteristics of physicians, their practice or clinical skills, their interactions with the patient, finances, in addition to a number of social factors. Moreover, the level of trust had major implications on patients’ interactions with their physicians. Electronic supplementary material The online version of this article (10.1186/s12913-019-4354-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bashir Shaya
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Nadine Al Homsi
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Kevin Eid
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Zeinab Haidar
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Ali Khalil
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Kelly Merheb
- School of Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Gladys Honein-Abou Haidar
- Hariri School of Nursing, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon
| | - Elie A Akl
- Department on Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020, Lebanon.
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Lexchin J. Financial conflicts of interest of clinicians making submissions to the pan-Canadian Oncology Drug Review: a descriptive study. BMJ Open 2019; 9:e030750. [PMID: 31350254 PMCID: PMC6661552 DOI: 10.1136/bmjopen-2019-030750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study examines financial conflict of interest (FCOI) of clinicians who made submissions to the pan-Canadian Oncology Drug Review (pCODR), the arm of the Canadian Agency for Drugs and Technology in Health that recommends whether oncology drug indications should be publicly funded. Final reports from pCODR published between October 2016 and February 2019 were examined. DESIGN Descriptive study. DATA SOURCES Website of pCODR. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOMES The primary outcome is the number of submissions declaring FCOI. Secondary outcomes are the number of times where clinicians agreed and disagreed with preliminary recommendation from pCODR and the association between the distribution of individual clinicians' FCOI and pCODR's funding recommendations. RESULTS There were 46 drug indication reports from pCODR. Clinicians made 261 submissions. Clinicians declared they received payments from companies 323 times and named 38 different companies making those payments a total of 500 times. Financial conflicts with drug companies were declared in 176 (66.3%) of all submissions. In 21 (45.7%) of the 46 drug indications, 50% or more of the clinicians had a conflict with the company making the drug. Clinicians commented on 37 preliminary recommendations. In all 25 where pCODR recommended funding or conditional funding, the clinicians either agreed or agreed in part. pCODR recommended that the drug indication not be funded 12 times and 9 times clinicians disagreed with that recommendation. The distribution of clinician responses was statistically significantly different depending on whether pCODR recommended funding/conditional funding or do not fund p<0.0001 (Fisher exact test). The distribution of clinicians' FCOI differed depending on whether the recommendation was fund/conditional fund or do not fund p=0.027 (Fisher exact test). CONCLUSION Financial conflicts with pharmaceutical companies are widespread among experts making submissions to the pCODR.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
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Kanter GP, Carpenter D, Lehmann LS, Mello MM. US Nationwide Disclosure of Industry Payments and Public Trust in Physicians. JAMA Netw Open 2019; 2:e191947. [PMID: 30977850 PMCID: PMC6481437 DOI: 10.1001/jamanetworkopen.2019.1947] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Transparency of industry payments to physicians could engender greater public trust in physicians but might also lead to greater mistrust of physicians and the medical profession, adversely affecting the patient-physician relationship. OBJECTIVE To examine the association between nationwide public disclosure of industry payments and Americans' trust in their physicians and trust in the medical profession. DESIGN, SETTING, AND PARTICIPANTS Survey study using difference-in-difference analyses of a national longitudinal survey comparing changes in states where industry payments were newly disclosed by Open Payments with changes in states where payments information was already available because of state sunshine laws. The US population-based surveys were conducted in September 2014-shortly before the initial public disclosure of industry payments-and again in September 2016. Final analyses were conducted September through December 2018. Participants were adults 18 years and older (n = 1388). EXPOSURES National public disclosure through Open Payments of payments made by pharmaceutical and medical device firms to physicians. MAIN OUTCOMES AND MEASURES Wake Forest measure of trust in one's own physician and Wake Forest measure of trust in the medical profession. RESULTS Of the 3542 original survey respondents, 2180 (61.5%) completed the second survey 2 years later, and 1388 named the same most frequently seen physician in both surveys. The mean age of respondents at the time of the first survey was 53 years, and 749 (54.0%) were women. Race/ethnicity was white in 76.6% (1063 of 1388) and non-Hispanic black in 8.0% (111 of 1388). Public disclosure of payments was associated with lower trust in one's own physician regardless of whether respondents knew their physicians had received payments (decrease in Wake Forest measure of trust in one's own physician of 0.56 point; 95% CI, -0.79 to -0.32 point; P < .001). Open Payments was also associated with lower trust in the medical profession (decrease in Wake Forest measure of trust in the medical profession of 0.35 point; 95% CI, -0.58 to -0.12 point; P = .004). CONCLUSIONS AND RELEVANCE Nationwide public disclosure of industry payments may be associated with decreased trust in physicians and in the medical profession. More judicious presentation of payments information may counteract unintended negative trust and spillover consequences of public disclosure.
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Affiliation(s)
- Genevieve P. Kanter
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Daniel Carpenter
- Radcliffe Institute for Advanced Study, Harvard University, Cambridge, Massachusetts
- Department of Government, Harvard University, Cambridge, Massachusetts
| | - Lisa S. Lehmann
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC
| | - Michelle M. Mello
- Stanford Law School, Stanford University, Stanford, California
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Campos-Castillo C. Exploring skin color and black-white differences in trust in physicians in a cross-sectional study of U.S. adults. J Natl Med Assoc 2019; 111:393-406. [PMID: 30777382 DOI: 10.1016/j.jnma.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research on skin color inequality is growing, but few studies examine the health care context. OBJECTIVE This study explored associations between black and white respondents' skin color and their trust in physicians using the 2012 General Social Survey (n = 1026), which is a national survey of U.S. adults. METHODS Bivariate and multivariable analyses examined how trust in physician is related to skin color and race. Five items measuring trust were aggregated using three different methods (summation, averaging, scaling) and disaggregated (estimated one item at a time) in analyses. RESULTS Across the three aggregation methods, neither skin color nor race were independently related to trust. For the disaggregation method, darker skin was associated with less trust that physicians to discuss all treatment options among white females, black females, and black males. Among white males, darker skin increased this trust. CONCLUSION Aggregating trust items and relying on only self-reported race may produce false conclusions about a lack of racial differences. Skin color is associated with complex concerns about physicians withholding treatment, which may reduce shared decision-making and treatment adherence. Skin color should be tracked to better capture health care experiences and population health.
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Nusrat S, Syed T, Nusrat S, Chen S, Chen WJ, Bielefeldt K. Assessment of Pharmaceutical Company and Device Manufacturer Payments to Gastroenterologists and Their Participation in Clinical Practice Guideline Panels. JAMA Netw Open 2018; 1:e186343. [PMID: 30646328 PMCID: PMC6324539 DOI: 10.1001/jamanetworkopen.2018.6343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. OBJECTIVES To investigate the nature and amounts of monetary and other benefits that gastroenterologists received and to determine the participation of those receiving benefits in the formulation of clinical practice guidelines. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed information from the Centers for Medicare & Medicaid Services Open Payments database, including all reports about payments that pharmaceutical and device manufacturers gave to adult or pediatric gastroenterologists in 2016. PubMed was used to examine the professional affiliations and publication records of top payment recipients. Panelists of clinical guidelines who also received personal financial rewards listed in the Open Payments database were identified. MAIN OUTCOMES AND MEASURES Payments made to gastroenterologists by pharmaceutical company and device manufacturers. RESULTS Of 15 497 gastroenterologists, 13 467 (86.9%) received a total of 432 463 payments accounting for a total expenditure of $67 144 862. Direct financial payments for consultations, talks, or other services were made to 2055 physicians and were responsible for 4.2% of payments (18 179 of 432 463), but for 62.7% of total expenditures ($42 086 207 of $67 144 862). Although a significant number of submissions were for food and beverages, they constituted only a small amount of total expenditure. For gastroenterologists treating adult patients, 10 products were linked to 63.8% of payments (11 221 of 17 588) related to direct financial rewards and 37.1% of the total expenditures ($24 892 643 of $67 144 862). Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts exceeding $10 000 in 8 of them (22%). CONCLUSIONS AND RELEVANCE Most gastroenterologists accept meals or gifts from industry, with 2055 of 15 497 gastroenterologists receiving direct payments and 8 of 36 clinical practice guidelines panelists having received more than $10 000. Considering the known impact of such benefits on prescribing patterns and other professional behaviors, policy makers should consider revising regulations governing interactions with industry and disclosure formats alerting others to their potential biasing impact.
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Affiliation(s)
- Salman Nusrat
- Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- Section of Digestive Diseases and Nutrition, Department of Medicine, Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Taseen Syed
- Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- Section of Digestive Diseases and Nutrition, Department of Medicine, Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Sanober Nusrat
- Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- Section of Digestive Diseases and Nutrition, Department of Medicine, Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City
| | - Wei-Jen Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City
| | - Klaus Bielefeldt
- Section of Gastroenterology, Department of Medicine, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
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Sah S, Loewenstein G, Cain D. Insinuation Anxiety: Concern That Advice Rejection Will Signal Distrust After Conflict of Interest Disclosures. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2018; 45:1099-1112. [DOI: 10.1177/0146167218805991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Conflict of interest disclosure as an expertise cue: Differential effects due to automatic versus deliberative processing. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2018. [DOI: 10.1016/j.obhdp.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Grundy Q, Habibi R, Shnier A, Mayes C, Lipworth W. Decoding disclosure: Comparing conflict of interest policy among the United States, France, and Australia. Health Policy 2018; 122:509-518. [PMID: 29605526 DOI: 10.1016/j.healthpol.2018.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/05/2017] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
"Sunshine" policy, aimed at making financial ties between health professionals and industry publicly transparent, has recently gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be. We used Carol Bacchi's problem-questioning approach to policy analysis to compare the Sunshine policies in three different jurisdictions, the United States, France and Australia. We found that transparency had emerged as a solution to several different problems including misuse of tax dollars, patient safety and public trust. Despite these differences in the origins of disclosure policies, all were underpinned by the questionable assumption that informed consumers could address conflicts of interest. We conclude that, while transparency reports have provided an unprecedented opportunity to understand the reach of industry within healthcare, policymakers should build upon these insights and begin to develop policy solutions that address systemic commercial influence.
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Affiliation(s)
- Quinn Grundy
- Charles Perkins Centre, School of Pharmacy, The University of Sydney, Australia.
| | | | | | - Christopher Mayes
- Sydney Health Ethics, School of Public Health, The University of Sydney, Australia; Alfred Deakin Institute, Deakin University, Australia
| | - Wendy Lipworth
- Sydney Health Ethics, School of Public Health, The University of Sydney, Australia
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Young PD, Xie D, Schmidt H. Towards Patient-Centered Conflicts of Interest Policy. Int J Health Policy Manag 2018; 7:112-119. [PMID: 29524935 PMCID: PMC5819371 DOI: 10.15171/ijhpm.2017.128] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/17/2017] [Indexed: 11/09/2022] Open
Abstract
Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians' medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians' reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians' professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices.
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Affiliation(s)
- Peter D. Young
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Dawei Xie
- Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harald Schmidt
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Capsule Commentary on Hwong et al., The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment. J Gen Intern Med 2017; 32:1247. [PMID: 28900811 PMCID: PMC5653566 DOI: 10.1007/s11606-017-4176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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