A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts

Orthopaedic Surgery and Indusry: What our Potential Patients Believe

PURPOSE

Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship.

METHODS

An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An "attention check" question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data.

RESULTS

A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was "important" or "extremely important" to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was "important" or "extremely important" to disclose partial ownership within industry. Seventy-one percent of respondents stated it was "important" or "extremely important" to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment.

DISCUSSION

In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate.

LEVEL OF EVIDENCE

2c, Ecological studies.

Public perceptions of physician-pharmaceutical industry relationships and trust in physicians

BACKGROUND

In Japan, as elsewhere, physicians meet with and receive gifts from pharmaceutical representatives (PRs). This study aimed to clarify the Japanese public perceptions of physicians' relationships with PRs, examine the association between these perceptions and their trust in physicians, and compare the public's and physicians' awareness, acceptance, and perceptions of the influence of physician-PR relationships.

METHODS

A cross-sectional, self-administered, anonymous, internet-panel survey was conducted involving 1,000 participants from the general public. The survey implementation was contracted to Cross Marketing Inc.

RESULTS

The mean age of the 1000 participants was 44.8 years (standard deviation 18.3). Forty-eight percent were female. Many of our participants were unaware of certain physician-PR relationships. The public was more acceptable with physicians' receiving stationery and/or medical textbooks and attending promotional drug seminars at their workplaces compared with receiving meals at restaurants. Many thought that physicians' involvement in promotional activities influenced their prescribing habits and estimated that the majority of physicians received office stationery and meals from PRs. They were divided as to whether they would like to know about their physicians' relationships with the industry. Factors associated with higher trust in physicians included participants being 65 years or older, having a primary care physician, being in better health, the belief that physicians' involvement in promotional activities is acceptable, and their high estimate that physicians are not receiving gifts from PRs. Compared to the physicians, the public had lower awareness of and was more accepting of physicians' involvement in promotional activities. Meanwhile, the public believed that physician-PR relationships influenced physicians' prescribing habits more than the physicians themselves.

CONCLUSION

Our survey provided insights into Japanese public perceptions of physician-pharmaceutical industry relationships and their impact on trust in physicians. Physicians should be aware of these perceptions and carefully consider how to foster appropriate relationships with the industry.

Mapping conflict of interests: scoping review

OBJECTIVE

To identify all known ties between the medical product industry and the healthcare ecosystem.

DESIGN

Scoping review.

METHODS

From initial literature searches and expert input, a map was created to show the network of medical product industry ties across parties and activities in the healthcare ecosystem. Through a scoping review, the ties were then verified, cataloged, and characterized, with data abstracted on types of industry ties (financial, non-financial), applicable policies for conflict of interests, and publicly available data sources.

MAIN OUTCOME MEASURES

Presence and types of medical product industry ties to activities and parties, presence of policies for conflict of interests, and publicly available data.

RESULTS

A map derived through synthesis of 538 articles from 37 countries shows an extensive network of medical product industry ties to activities and parties in the healthcare ecosystem. Key activities include research, healthcare education, guideline development, formulary selection, and clinical care. Parties include non-profit entities, the healthcare profession, the market supply chain, and government. The medical product industry has direct ties to all parties and some activities through multiple pathways; direct ties extend through interrelationships among parties and activities. The most frequently identified parties were within the healthcare profession, with individual professionals described in 422 (78%) of the included studies. More than half (303, 56%) of the publications documented medical product industry ties to research, with clinical care (156, 29%), health professional education (145, 27%), guideline development (33, 6%), and formulary selection (8, 1%) appearing less often. Policies for conflict of interests exist for some financial and a few non-financial ties; publicly available data sources seldom describe or quantify these ties.

CONCLUSIONS

An extensive network of medical product industry ties to activities and parties exists in the healthcare ecosystem. Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.

A study of perceptions and exposure of drug promotional literature among clinicians in a teaching hospital

BACKGROUND

Drug promotional literature (DPL) forms a major marketing technique of pharmaceutical companies for propagating information regarding a drug. Many a times, it is the only source on which treating physicians depend for updating their knowledge about the existing and novel drugs.

AIMS AND OBJECTIVES

This study was conducted to understand the clinicians' perceptions about DPL and its critical appraisal so that relevant interventions can be made.

MATERIALS AND METHODS

It was a cross-sectional questionnaire based study. A self-administered validated questionnaire was administered to 125 clinicians working in a medical college, which sought responses on their perception of various aspects including interpretation, analysis, evaluation, inference and decision making based on the DPL which they encounter in their day-to-day practices. The data was analyzed using descriptive statistics.

RESULTS

A total of 100 clinicians reciprocated with complete questionnaire. 99% of the clinicians were exposed to pharmaceutical promotional activities and around 79% clinicians accepted that drug promotion has a considerable bearing on their prescribing practices. Majority (79%) of the clinicians felt that the accuracy of the claims in the various forms of DPL was between 50-75%. Amongst the various forms of DPL, brochures were adjudged as the most useful followed by interactions with medical representatives, advertisements in medical journals and direct mailers. a majority of the clinicians (69%) felt that, though the claims in the DPL are balanced but are supported by poor evidence. Around 75% clinicians perceived the primary intention of drug promotional literature was to boost company sales. Around 84% clinicians felt that doctors' integrity can be compromised by accepting gifts from medical representatives. Over 75% of clinicians believed that training in interacting with medical representatives and assessing other forms of drug promotional literature should be imparted to undergraduates in medical colleges.

CONCLUSION

Physicians need to be aware that the pharmaceutical industry may use drug advertisements to influence prescription patterns even when this results in distortion of scientific facts. The pharmaceutical industry should be more responsible and more meticulous in making sure that pharmaceutical claims referring to scientific studies are quoted accurately.

Influence of conflicts of interest on public positions in the COVID-19 era, the case of Gilead Sciences

Funding and gifts from the pharmaceutical industry have an influence on the decisions made by physicians and medical experts. In the context of the coronavirus disease 2019 epidemic, several treatments are available to treat patients infected with the virus. Some are protected by patents, such as remdesivir, others0020stare not, such as hydroxychloroquine. We wanted to observe the possible correlation between the fact, for an academic doctor in infectious diseases, of having benefited from funding by Gilead Sciences, producer of remdesivir, and the public positions taken by this doctor towards hydroxychloroquine. Our results show a correlation (Spearman test, p = 0.017) between the amount received from the Gilead Sciences company and public opposition to the use of hydroxychloroquine in France. This should open up the debate on the role of the interest links of doctors with pharmaceutical companies in the medical and scientific public debate.

Association between Opioid Prescribing in Medicare and Pharmaceutical Company Gifts by Physician Specialty

BACKGROUND

The association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown.

OBJECTIVE

To examine the relationship between opioid-related gifts to physicians and opioid prescribing in the subsequent year across 7 physician specialties.

DESIGN

Panel study using data from 2014 to 2016.

PARTICIPANTS

236,103 unique Medicare Part D physicians (389,622 physician-years) who received any gifts from pharmaceutical companies measured using Open Payments and prescribed opioids in the subsequent year.

MAIN MEASURES

Amounts paid by pharmaceutical companies for opioid-related gifts including meals and lodging; quartile of opioid prescribing as a percent of total prescribing compared with other same-specialty physicians.

KEY RESULTS

In 2014-2015, 14.1% of physician received opioid-related gifts from the industry with 2.6% receiving > $100. Gifts varied by specialty and were concentrated among two pharmaceutical companies responsible for 60% of the value of opioid-related gifts. Receiving opioid-related gifts was associated with greater prescribing of opioids compared with same-specialty physicians in the next year. Primary care physicians are nearly 3.5 times as likely to be in the highest quartile of prescribing versus the lower quartiles if they were paid ≥ $100. Psychiatrists and neurologists were 7 to 13 times as likely to be in a higher quartile of opioid prescribing compared with colleagues who were paid $0 in the preceding year.

CONCLUSIONS

The value of opioid-related gifts given to physicians varies substantially by provider specialty, as does the relationship between payment amounts and prescriber behavior in the following year.

Exploring the Psychiatrist-Industry Financial Relationship: Insight from the Open Payment Data of Centers for Medicare and Medicaid Services

OBJECTIVE

The Physician Payments Sunshine Act (PPSA) requires reporting of financial payments by pharmaceutical and medical device companies to teaching hospitals and individual physicians in the US. Industry payments made to psychiatrists were quantified.

METHODS

Using the 2016-2017 Sunshine Act Open Payments database, general payments made to psychiatrists were descriptively analyzed. The number of psychiatrists who received payments, and median number, value (in US dollar), and nature of payments to psychiatrists were quantified. Top 10 manufacturers who paid the most to psychiatrists were also reported.

RESULTS

Over half of active psychiatrists (55.7%) received some form of payments from pharmaceutical manufacturers. Of these, top 2.8% of psychiatrists received 82.6% of the payments. Pharmaceutical manufacturers provided 812,877 payments worth $110,512,607.18 to 26,422 psychiatrists in the US. Compensation for services (e.g., speaker's bureaus) and consulting fees altogether constituted 71.4% of the total payment, with a median value of $1725.00 and $700, respectively. Among all psychiatrists who received payments, manufacturers that paid the most included Otsuka Pharmaceuticals, Alkermes, and Sunovion Pharmaceuticals.

CONCLUSIONS

The PPSA was created to foster transparent disclosure of any financial relationship between physicians and industry. Findings highlight that many active psychiatrists receive payments from pharmaceutical industry and payment forms were varied (e.g., food/beverage, educational materials, and compensation for services).

Are Investors Warned by Disclosure of Conflicts of Interest? The Moderating Effect of Investment Horizon

Financial analysts are required to disclose conflicts of interest (COI) in their research reports, but there is limited evidence on the effectiveness of COI disclosures. We investigate whether the influence of disclosing COI in analyst reports on investors' decision making depends on investment horizon. Experimental results show that short-term investors who view a COI disclosure are significantly less willing to invest in the recommended stock compared to short-term investors who do not view such a disclosure, while the presence of a COI disclosure does not significantly affect long-term investors' willingness to invest. Results further demonstrate that the COI disclosure decreases short-term investors' willingness to invest by reducing their perception of analysts' trustworthiness and expertness. This study provides evidence on when and how the COI disclosure can influence investors' behavior and enhances our understanding of investors' reactions to cautionary disclaimers.

Data Availability: Contact the authors.

Accuracy Between AJSM Author-Reported Disclosures and the Centers for Medicare and Medicaid Services Open Payments Database

BACKGROUND

Inaccurate disclosures of physician and industry relationships in scientific reporting may create an asymmetry of information by hiding potential biases. The accuracy of conflict of interest disclosure in sports medicine research is unknown.

PURPOSE

To compare author financial disclosures in published articles in 2016 in the American Journal of Sports Medicine ( AJSM) with the Centers for Medicare and Medicaid Services' Open Payments Database (OPD) to determine the percentage of payments values and percentage of eligible authors with discrepancies.

STUDY DESIGN

Cross-sectional study; no level of evidence (nonclinical).

METHODS

All articles published in 2016 in AJSM were screened to identify eligible authors. On the basis of OPD reporting, physician authors affiliated with a US institution were included. Stated disclosures in AJSM publications for these authors were identified and compared with industry-reported payments on OPD.

RESULTS

A total of 434 authors were included in this study. Mean and median total payments per author per year were $76,941 and $1692, respectively. The most commonly received payment was for food and beverage (81.3% of authors), followed by travel and lodging (45.4%) and consulting (31.8%). Authors with higher total payments were less likely to be discrepant in their reporting-notably, authors earning >$500,000 had 16.1% of payment values with discrepancy, as opposed to 85.3% for those earning <$10,000 ( P < .001). First authors had a lower percentage of payment values with discrepancy (13.8%) versus middle authors (31.9%, P = .001). Finally, men had a lower percentage of payment values with discrepancy (418 authors, 22.3% of payment values with discrepancy) as compared with women (16 authors, 95.3%; P < .001). Regarding industry payments specifically requested on the AJSM disclosure form for authors (royalties, consulting, research payments, and ownership and investments), only 25.3% of authors had a discrepancy in these payment categories in aggregate.

CONCLUSION

Discrepancies exist between disclosures reported by authors publishing in AJSM and what is reported in the OPD. Authors receiving lower total payments, middle authors, and women are more likely to have disclosure discrepancies. Additionally, industry research funding support and ownership interest are most likely to go unreported. However, this study did not assess whether authors with industry payments preferentially published studies pertaining to products from companies from which they received funding. As national registries such as the OPD are increasingly utilized, physicians may benefit from referencing such databases before submitting conflict of interest disclosures.

Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians' attitudes and prescribing habits: a systematic review

OBJECTIVES

The objective of this review is to explore interactions between physicians and the pharmaceutical industry including sales representatives and their impact on physicians' attitude and prescribing habits.

DATA SOURCES

PubMed, Embase, Cochrane Library and Google scholar electronic databases were searched from 1992 to August 2016 using free-text words and medical subject headings relevant to the topic.

STUDY SELECTION

Studies included cross-sectional studies, cohort studies, randomised trials and survey designs. Studies with narrative reviews, case reports, opinion polls and letters to the editor were excluded from data synthesis.

DATA EXTRACTION

Two reviewers independently extracted the data. Data on study design, study year, country, participant characteristics, setting and number of participants were collected.

DATA SYNTHESIS

Pharmaceutical industry and pharmaceutical sales representative (PSR) interactions influence physicians' attitudes and their prescribing behaviour and increase the number of formulary addition requests for the company's drug.

CONCLUSION

Physician-pharmaceutical industry and its sales representative's interactions and acceptance of gifts from the company's PSRs have been found to affect physicians' prescribing behaviour and are likely to contribute to irrational prescribing of the company's drug. Therefore, intervention in the form of policy implementation and education about the implications of these interactions is needed.

A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why

Medical professional societies each develop specific clinical practice guidelines (CPGs). Based on the best available evidence, CPGs are intended to control variability and optimize quality of care in clinical practice. Yet, healthcare providers often do not accept or adhere to guidelines, but their reasons are not fully understood. When providers opt to choose not to follow CPGs, unfavorable patient outcomes including unequal access to treatment become negative consequences. In this small qualitative study, we will explore what causes non-adherence to CPGs and what changes have been made to CPGs from when physicians completed their medical residencies to the present. We interviewed physicians from a variety of medical specialties to assess how these changes may influence guideline adherence as well as the consequences of not following them. We found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. In some specialties, physicians can develop a poor reputation if they do not adhere to the CPGs, and managed care agencies may deny reimbursement for care they provided. To best serve the physician and the patient, we need to find ways to improve CPG adherence. Tactics such as improving the methodology of CPG formation, using information technology, and creating ways to change physician attitudes and behavior are all viable options.

Bringing Transparency to Medicine: Exploring Physicians' Views and Experiences of the Sunshine Act

The Physician Payments Sunshine Act (PPSA) requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest (COI) and build patient trust-crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company "perks." Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data.

The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab

INTRODUCTION

The influence of financial ties to pharmaceutical companies remains controversial. We aimed to assess a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab.

MATERIALS AND METHODS

Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Medicare B) data containing 2012 claims compared to OpenPayments (Sunshine Act) data for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated dataset. Adjusted beneficiary count and total Medicare reimbursement were compared according to receipt of Sunshine payment, and an association between Sunshine payment amount and total Medicare reimbursement was also assessed.

RESULTS

Of the 160 prescribers of degarelix and 1,507 prescribers of denosumab, 91 (57%) and 854 (57%) received Sunshine payment, respectively. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement ($13,257 vs. $9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had both higher median adjusted beneficiary count (55 vs. 50, p < 0.001) and median total Medicare reimbursement ($69,620 vs. $60,732, p < 0.001). On multivariable analysis, both receipt of Sunshine payment (adjusted median difference $5,844, 95% CI $937 - $10,749) and oncology specialty (adjusted median difference $34,380, 95% CI $26,715 - $42,045) were independently associated with total Medicare reimbursement for denosumab.

CONCLUSIONS

In the case of degarelix and denosumab, there is a weak association between pharmaceutical company payments on prescribers' prescription behavior patterns.

Sunshine Act: shedding light on inaccurate disclosures at a gynecologic annual meeting

BACKGROUND

Physicians and hospital systems often have relationships with biomedical manufacturers to develop new ideas, products, and further education. Because this relationship can influence medical research and practice, reporting disclosures are necessary to reveal any potential bias and inform consumers. The Sunshine Act was created to develop a new reporting system of these financial relationships called the Open Payments database. Currently all disclosures submitted with research to scientific meetings are at the discretion of the physician. We hypothesized that financial relationships between authors and the medical industry are underreported.

OBJECTIVES

We aimed to describe concordance between physicians' financial disclosures listed in the abstract book from the 41st annual scientific meeting of the Society of Gynecologic Surgeons to physician payments reported to the Center for Medicaid and Medicare Services Open Payments database for the same year.

STUDY DESIGN

Authors and scientific committee members responsible for the content of the 41st annual scientific meeting of the Society of Gynecologic Surgeons were identified from the published abstract book; each abstract listed disclosures for each author. Abstract disclosures were compared with the transactions recorded on the Center for Medicaid and Medicare Services Open Payments database for concordance. Two authors reviewed each nondisclosed Center for Medicaid and Medicare Services listing to determine the relatedness between the company listed on the Center for Medicaid and Medicare Services and abstract content.

RESULTS

Abstracts and disclosures of 335 physicians meeting inclusion criteria were reviewed. A total of 209 of 335 physicians (62%) had transactions reported in the Center for Medicaid and Medicare Services, which totaled $1.99 million. Twenty-four of 335 physicians (7%) listed companies with their abstracts; 5 of those 24 physicians were concordant with the Center for Medicaid and Medicare Services. The total amount of all nondisclosed transactions was $1.3 million. Transactions reported in the Center for Medicaid and Medicare Services associated with a single physician ranged from $11.72 to $405,903.36. Of the 209 physicians with Center for Medicaid and Medicare Services transactions that were not disclosed, the majority (68%) had at least 1 company listed in the Center for Medicaid and Medicare Services that was determined after review to be related to the subject of their abstract.

CONCLUSION

Voluntary disclosure of financial relationships was poor, and the majority of unlisted disclosures in the abstract book were companies related to the scientific content of the abstract. Better transparency is needed by physicians responsible for the content presented at gynecological scientific meetings.

Knowledge, Beliefs and Attitudes of Patients and the General Public towards the Interactions of Physicians with the Pharmaceutical and the Device Industry: A Systematic Review

OBJECTIVE

To systematically review the evidence on the knowledge, beliefs, and attitudes of patients and the general public towards the interactions of physicians with the pharmaceutical and the device industry.

METHODS

We included quantitative and qualitative studies addressing any type of interactions between physicians and the industry. We searched MEDLINE and EMBASE in August 2015. Two reviewers independently completed data selection, data extraction and assessment of methodological features. We summarized the findings narratively stratified by type of interaction, outcome and country.

RESULTS

Of the 11,902 identified citations, 20 studies met the eligibility criteria. Many studies failed to meet safeguards for protecting from bias. In studies focusing on physicians and the pharmaceutical industry, the percentages of participants reporting awareness was higher for office-use gifts relative to personal gifts. Also, participants were more accepting of educational and office-use gifts compared to personal gifts. The findings were heterogeneous for the perceived effects of physician-industry interactions on prescribing behavior, quality and cost of care. Generally, participants supported physicians' disclosure of interactions through easy-to-read printed documents and verbally. In studies focusing on surgeons and device manufacturers, the majority of patients felt their care would improve or not be affected if surgeons interacted with the device industry. Also, they felt surgeons would make the best choices for their health, regardless of financial relationship with the industry. Participants generally supported regulation of surgeon-industry interactions, preferably through professional rather than governmental bodies.

CONCLUSION

The awareness of participants was low for physicians' receipt of personal gifts. Participants also reported greater acceptability and fewer perceived influence for office-use gifts compared to personal gifts. Overall, there appears to be lower awareness, less concern and more acceptance of surgeon-device industry interactions relative to physician-pharmaceutical industry interactions. We discuss the implications of the findings at the patient, provider, organizational, and systems level.

Utilization of free medication samples in the United States in a nationally representative sample: 2009-2013

BACKGROUND

Manufacturers provide free sample medications as a means to increase use of branded medications. Sample use varies year-to-year as branded product patents expire and new products come to market.

OBJECTIVE

This study sought to describe the use of sample medications during 2009-2013 and assess individual characteristics associated with sample use.

METHODS

Data from the 2009-2013 U.S. Medical Expenditure Panel Survey (MEPS) were used. MEPS asks participants whether they received each medication they are taking as a sample. The top 10 medications and medication classes used each year by volume were identified as well as the proportion of people who used at least one sample medication. The proportion of new initiators of medications were also classified as the percent who received a sample for the specific medication. Logistic regression was used to assess individual demographics, insurance, and medication characteristics associated with use.

RESULTS

Prevalence of sample use ranged from 9.3% in 2009 to 6.2% in 2013. The most widely used sample medications included statins during 2009-2011, which changed to inhaled β-agonists in 2012-2013, as atorvastatin became available as a generic. The overall volume of the top 10 free sample medications decreased by one-third over this study period. In 2013, 12.6% of new insulin analog users and 11.0% of new oral contraceptive users receive these medications through samples. Regression analysis showed that U.S. Medicaid- and Medicare-insured persons were less likely to use samples compared to those with private insurance.

CONCLUSIONS

Sample medication use has decreased as generic medications are becoming more used in the U.S.

Validity of tools used for surveying physicians about their interactions with pharmaceutical company: a systematic review

BACKGROUND

There is evidence that physicians' prescription behavior is negatively affected by the extent of their interactions with pharmaceutical companies. In order to develop and implement policies and interventions for better management of interactions, we need to understand physicians' perspectives on this issue. Surveys addressing physicians' interactions with pharmaceutical companies need to use validated tools to ensure the validity of their findings.

OBJECTIVE

To assess the validity of tools used in surveys of physicians about the extent and nature of their interactions with pharmaceutical companies, and about their knowledge, beliefs and attitudes towards such interactions; and to identify those tools that have been formally validated.

METHODS

We developed a search strategy with the assistance of a medical librarian. We electronically searched MEDLINE and EMBASE databases in September 2015. Teams of two reviewers conducted data selection and data abstraction. They identified eligible studies in one table and then abstracted the relevant data from the studies with validated tools in another table. Tables were piloted and standardized.

RESULTS

We identified one validated questionnaire out of the 11 assessing the nature and extent of the interaction, and three validated questionnaires out of the 47 assessing knowledge, beliefs and attitudes of physicians toward the interaction. None of these validated questionnaires were used in more than one survey.

CONCLUSION

The available supporting evidence of the issue of physicians' interaction with pharmaceutical company is of low quality. There is a need for research to develop and validate tools to survey physicians about their interactions with pharmaceutical companies.

The Physician Payments Sunshine Act: data evaluation regarding payments to ophthalmologists

PURPOSE

To review data for ophthalmologists published online from the Physician Payments Sunshine Act.

DESIGN

Retrospective data review using data acquired from a publicly available electronic database.

METHODS

A database was downloaded from the Centers for Medicare and Medicaid Services website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median, and range of payments for both single payments and per provider.

MAIN OUTCOME MEASURES

Data summary by category of payment and geographic region and comparison with other surgical subspecialties.

RESULTS

From August 1, 2013, through December 31, 2013, a total of 55 996 individual payments were reported to 9855 ophthalmologists for a total of $10 926 447. The mean amount received in a single payment was $195.13 (range, $0.04-$193 073). The mean amount received per physician identifier (ID) was $1108 (range, $1-$397 849), and the median amount was $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery, and urology ranged from $954 to $6980, and median payments in each field by physician ID ranged from $88 to $173.

CONCLUSIONS

A large amount of data were released by the Centers for Medicare and Medicaid Services for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were less than $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care, and medical costs warrants further study.

To see, or not to see, that is the question: can public disclosure really improve transparency between medicine and the pharmaceutical industry?

OBJECTIVE

To critically review the potential effect of the public reporting of pharmaceutical company payments to healthcare professionals on the relationship between medicine and industry.

METHOD

This review is based on an examination of the 'Transparency Model' put out recently for consultation by Medicines Australia.

RESULTS

Public reporting in itself will neither sharpen the boundaries between medicine and the pharmaceutical industry nor restore public confidence.

CONCLUSIONS

Focusing on payments for clinical research and on the larger payments to healthcare professionals would lead to a better understanding of the interplay between science and marketing.

Interactions between physicians and pharmaceutical sales representatives in Saudi Arabia

BACKGROUND AND OBJECTIVES

Interaction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction.

DESIGN AND SETTINGS

A cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012.

METHODS

A cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats.

RESULTS

A total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P < .001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status.

CONCLUSION

Although lower than seen in many parts of the world, a high prevalence of physician-PR inter.action in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.

Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing?

BACKGROUND

Academic medical institutions have instituted conflict of interest (COI) policies in response to concerns about pharmaceutical industry influence.

OBJECTIVE

To determine whether exposure to COI policies during psychiatry residency training affects psychiatrists' antidepressant prescribing patterns after graduation.

RESEARCH DESIGN

We used 2009 physician-level national administrative prescribing data from IMS Health for 1652 psychiatrists from 162 residency programs. We used difference-in-differences estimation to compare antidepressant prescribing based on graduation before (2001) or after (2008) COI policy adoption across residency program groups with maximally, moderately, and minimally restrictive COI policies. The primary outcomes were shares of psychiatrists' prescribing of heavily promoted, brand reformulated, and brand antidepressants.

RESULTS

Rates of prescribing heavily promoted, brand reformulated, and brand antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness. However, differences between pre-COI and post-COI graduates' prescribing of heavily promoted medications were larger for maximally restrictive programs than both minimally restrictive programs [-4.3 percentage points; 95% confidence interval (CI), -7.0, -1.6] and moderately restrictive programs (-3.6 percentage points; 95% CI, -6.2, -1.1). The difference in prescribing reformulations was larger for maximally restrictive programs than minimally restrictive programs (-3.0 percentage points; 95% CI, -5.3, -0.7). Results were consistent for prescribing of brand drugs.

CONCLUSIONS

This study provides the first empirical evidence of the effects of COI policies. Our results suggest that COI policies can help inoculate physicians against persuasive aspects of pharmaceutical promotion. Further research should assess whether these policies affect other drug classes and physician specialties similarly.

Treatment compliance under physician-industry relationship: a framework of health-care coordination in the USA

OBJECTIVE

Factors associated with treatment compliance have been well studied. However, no study has examined treatment compliance under the context of physician-industry relationship. This study developed a conceptual framework of physician-industry relationship and treatment compliance, and empirically tested patients' treatment compliance and affordability under the physician-industry relationship in the USA.

DESIGN

We first proposed a conceptual framework to analyze different scenarios, where the physician-industry relationship could impact patients' treatment compliance and affordability, taking into consideration the role of health insurers. We then employed a nationally representative data set to investigate these relationships. Multivariable logistic regressions were employed to examine the physician-industry relationship and the physicians' perception of patients' treatment compliance.

SETTING AND PARTICIPANTS

2008 Health Tracking Physician Survey.

RESULTS

Our results showed that physicians with closer industry relationships were more likely to report rejection of care by insurers [odds ratios (ORs): 1.24-1.85, P < 0.001], patients' non-compliance with treatment (OR: 1.34, P < 0.01) and patients' inability to pay (OR: 1.42, P < 0.01) as the major problems affecting their ability to provide high quality care, when compared with physicians without industry relationships.

CONCLUSIONS

Our results shed light on the lack of articulation among industry, physicians and health insurers in the USA. It is important to make sure that different agents in the health-care marketplace, such as physicians, industry, and health insurers, coordinate more efficiently to provide quality and consistent care to patients.

Management of conflicts of interest in cardiovascular medicine

Conflicts of interest (COIs) are common and important in cardiovascular medicine. Although COIs do not automatically lead to bias, conflicts between financial considerations, fame, promotion, etc., threaten valued interests such as objectivity, integrity, patient protection and cost-savings. Strategies for managing COIs include disclosure, limitations and eliminations, each of which is employed in varying degrees by universities, funding and regulatory agencies, journal editors, providers of continuing medical education and professional societies. This paper describes benefits and pitfalls inherent in each of these strategies. There is no "gold standard" for the dealing with COIs in cardiovascular medicine, but finding ways to manage unavoidable COIs without compromising the benefits of productive relationships between investigators and industry will be essential to preserving valued interests and public trust in the cardiovascular profession.

Physicians, social media, and conflict of interest

Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media's potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of interest. Some guidelines do not explicitly mention conflict of interest; others recommend only disclosure. Recommending disclosure fails to appreciate the unique features of social media that make adequate disclosure difficult to accomplish. Moreover, in emphasizing disclosure alone, current guidelines are inconsistent with medicine's general trend toward management or elimination, not just disclosure, of potential conflicts. Because social media sites typically rely on physicians' voluntary compliance with professional norms, physicians necessarily play a major role in shaping these norms' content and scope. To achieve the benefits of social media and ensure the veracity of social media content while preserving trust in the profession, physicians must reaffirm their commitment to disclose potential conflicts; advocate for better electronic disclosure mechanisms; and develop concrete management strategies-including, where necessary, the elimination of conflicts altogether.

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system

BACKGROUND

Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system.

OBJECTIVE

To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system.

DESIGN

Cross sectional random digit dial telephone survey.

PARTICIPANTS

African-American and White adults in 40 large metropolitan areas.

MAIN MEASURES

Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust.

KEY RESULTS

Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62).

CONCLUSIONS

Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

A Study of Attitude and Knowledge of the Psychiatry Resident Doctors toward Clinician-Pharmaceutical Industry Interaction

BACKGROUND

Pharmaceutical industry and clinicians are the two important stakeholders in the modern-day health care. However, concerns have been expressed about the lack of congruence between the goals of these two.

AIMS

The current study aimed at exploring the knowledge and attitude of the psychiatry resident doctors toward the clinician-pharmaceutical industry interaction and also at exploring the knowledge of the residents about the new Medical Council of India guidelines on this issue.

MATERIALS AND METHODS

The survey was conducted among psychiatry residents. Descriptive statistics with frequency distribution was carried out by using SPSS version 17.0.

RESULTS

It had a good response rate of around 90%. The survey reveals the knowledge and attitude of the psychiatry residents toward the psychiatrist-pharmaceutical industry interaction.

CONCLUSIONS

The survey provides understanding in knowledge and attitude of the psychiatry residents towards the psychiatrist-pharmaceutical industry interaction.

National estimates and predictors of prescription medication sample use in the United States, 1999-2005

OBJECTIVES

To determine the prevalence of free medication sample use in the United States and analyze the effects of socioeconomic status and drug safety actions.

DESIGN

Cross-sectional study.

SETTING

United States from 1999 to 2005.

PARTICIPANTS

Survey respondents representative of the civilian noninstitutionalized population.

INTERVENTION

Analysis of data from the Medical Expenditure Panel Survey, a nationally representative longitudinal household survey.

MAIN OUTCOME MEASURES

Identification of a medication as being provided as a sample at least once during a study year.

RESULTS

An annual average of 5.1% (range 4.4% in 2005 to 5.8% in 2002) of all prescription medications were provided as a sample at least once during a year, with 18.3% of all Americans who received at least one prescription drug receiving at least one drug as a sample. On multivariate analysis, sample use was greater among young (18-30 years) non-Hispanic whites and the uninsured but had minimal independent association with income. The proportion of sample use among users of hormone replacement therapy and cyclooxygenase-2 inhibitors remained relatively constant even as total use of these drugs declined after Food and Drug Administration regulatory action.

CONCLUSION

Use of medication samples is common in the U.S. population. After adjusting for health insurance, sample use was not associated with income and samples were less frequently provided to racial/ethnic minorities and to the elderly. The putative economic benefits of free samples do not appear to go to patients with the greatest financial need. Drug regulatory actions did not have a disproportionate effect on provision of drugs as samples.

All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving

Much attention has been focused in recent years on the ethical acceptability of physicians receiving gifts from drug companies. Professional guidelines recognize industry gifts as a conflict of interest and establish thresholds prohibiting the exchange of large gifts while expressly allowing for the exchange of small gifts such as pens, note pads, and coffee. Considerable evidence from the social sciences suggests that gifts of negligible value can influence the behavior of the recipient in ways the recipient does not always realize. Policies and guidelines that rely on arbitrary value limits for gift-giving or receipt should be reevaluated.

Public perceptions of physician - pharmaceutical industry interactions: a systematic review

BACKGROUND

Interactions between physicians and the pharmaceutical industry have led to concerns about conflict of interest (COI), resulting in COI guidelines that suggest a threshold beyond which interactions may be considered unacceptable. Guidelines have also outlined the importance of public opinion on the topic. Consequently, we conducted a systematic review to determine the Canadian public's opinions of physician-pharmaceutical industry interactions.

METHODS

A systematic review of the standard health sciences literature as well as grey literature was conducted and a number of experts were contacted. Pre-determined eligibility criteria were used to identify appropriate studies. Meta-analysis of the study findings was not possible owing to the variety of methods of reporting outcomes, the types of interactions studied and the diversity of populations studied.

RESULTS

No studies on Canadian opinions were identified. Ten international studies (n=13,637), seven with patient groups and three with public citizens, were identified that examined opinions on aspects of awareness, acceptability, disclosure and perceived effects of physician-pharmaceutical industry interactions. Heterogeneity was observed in the awareness, acceptability and perceived effects of physician-pharmaceutical industry interactions; however, there appeared to be greater acceptability and fewer perceived effects with smaller, less costly interactions that directly benefit patients or a medical practice. Desire for disclosure of these interactions was consistent across studies.

INTERPRETATION

Research on the public's perception of physician-pharmaceutical industry interactions has been inadequate internationally and non-existent in Canada, and is urgently needed to help shape policies regarding potential conflict of interest.

[Frequency and type of gifts given by pharmaceutical industry to cardiology residents]

OBJECTIVE

Cardiovascular diseases are the leading cause of death in the world and cardiologists are an important target for the pharmaceutical industry. We evaluated cardiology residents' exposure to pharmaceutical companies.

METHODS

A survey was sent by e-mail in July 2009 to all residents of the Cardiology and Vascular Diseases program endorsed by the French Society of Cardiology.

RESULTS

The questionnaire was completed by 149 (56%) residents. Among them, 145 (97%) had at least one promotional item in their white coat. Non-educational gifts (such as pens and notepads) and scientific papers reprints are the most frequently received gifts. Pharmaceutical companies have invited 117 (79%) residents to a local or national congress and 42 (29%) to an international congress. Most residents consider gifts as ethically appropriate, particularly scientific textbooks, invitations to congresses and educational seminars. Among the 128 residents who assessed the value of a gift likely to compromise a physician's judgment, 36 (28%) answered < 100 euro, 51 (40%) between 101 and 1000 euro and 41 (32%) >1000 euro.

CONCLUSIONS

Cardiology residents in France frequently interact with the pharmaceutical industry, receiving not only small gifts but also support to their medical education. Interactions with industry are generally considered appropriate and training on their ethical implications and influence on prescribing could be implemented during residency.

Limiting the influence of pharmaceutical industry gifts on physicians: self-regulation or government intervention?

Concerns over the influence of pharmaceutical gifts on physicians have surged in recent years. This has prompted wide ranging legislative proposals in numerous states and in the federal government as well as stepped up efforts at self-regulation by the pharmaceutical industry and the medical profession. Policymakers face the decision of whether to defer to self-regulation or support government intervention. This commentary describes efforts at self-regulation by the pharmaceutical industry and the medical profession. The author examines and critiques the wide ranging legislative strategies pursued to limit the influence of pharmaceutical gifts on physicians and concludes with suggestions for policymakers and the profession to limit influence and preserve public trust.

The pitfalls of deducing ethics from behavioral economics: why the Association of American Medical Colleges is wrong about pharmaceutical detailing

The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do so is a prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment.

Expert opinion and controversies in musculoskeletal and sports medicine: conflict of interest

Standaert CJ, Schofferman JA, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: conflict of interest. Medical providers are faced with conflicts of interest (COIs) on a routine basis, but there is growing concern over the effects of COIs on medical care, medical education, research, product development, and other aspects of the health care system. The data clearly indicate that medical providers are subconsciously influenced by interactions with representatives of pharmaceutical and device manufacturers and that they are not very good at assessing the extent of this influence upon themselves. The data are also clear that potential bias arising from COIs is present in medical education and research. A number of professional medical associations have developed guidelines regarding interactions between medical providers and industry, and requirements for disclosure have become commonplace. The impact of these regulations and of disclosure on managing COI is unclear, however, and it is extremely important that providers manage the conflicts present on their own. A broad awareness of the effects of COIs and disclosure is necessary if providers are going to be able to offer the best care for their patients.

Industry relations with emergency medicine graduate medical education programs

A panel of physicians from the Society for Academic Emergency Medicine (SAEM) Graduate Medical Education (GME), Ethics, and Industry Relations Committees were asked by the SAEM Board of Directors to write a position paper on the relationship of emergency medicine (EM) GME with industry. Using multiple sources as references, the team derived a set of guidelines that all EM GME training programs can use when interacting with industry representatives. In addition, the team used a question-answer format to provide educators and residents with a practical approach to these interactions. The SAEM Board of Directors endorsed the guidelines in June 2009.