Evaluating industry payments to editorial board members of otolaryngology journals

OBJECTIVE

To evaluate the extent of payments from medical device and pharmaceutical companies to editorial board members of leading otolaryngology journals.

METHODS

Editorial board members of the top 10 otolaryngology journals from Google Scholar rankings were identified in this cross-sectional study. Payments between 2017 and 2022 were identified via the Open Payments Database from the Centers for Medicare and Medicaid Services. All payment data was adjusted for inflation in 2022 US dollars. Descriptive analyses were performed and journal websites were evaluated for individual editor disclosures.

RESULTS

Out of 581 board members, 306 (53 %) received industry payments between 2017 and 2022, median journal percentage 55 % (interquartile range: 26.5 %-73.5 %). A sum of $45.8 million was paid out between 2017 and 2022, comprising $32.0 million in associated research funding, $1.2 million in research payments, $1.4 million in ownership and investment interests, and $11.2 million in general payments. The largest general payments were made out for "services other than consulting and speaking" ($3.9 million), "consulting" ($3.8 million), "travel and lodging" ($0.99 million), "education" ($0.87 million), "royalty or license" ($0.56 million), and "food and beverage" ($0.55 million). Individual editor disclosures were only available for International Forum of Allergy and Rhinology (9 % of all included editors).

CONCLUSIONS

Industry payments to editors of otolaryngology journals are not uncommon. We highlight the need for improved reporting of individual editor disclosures for transparency to journal readers and for minimizing biased editorial decisions.

Evaluation of Conflict of Interest in Consulting Fee Payments in Plastic Surgery and Related Specialties

BACKGROUND

The Physician Payments Sunshine Act was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments constitute a large proportion of these financial relationships. The authors hypothesized that there are discrepancies among industry-derived consulting payments to medical and surgical specialties. The purpose of this study was to evaluate the distribution of consulting fee payments to plastic surgery and related specialties.

METHODS

This cross-sectional study used the publicly available Centers for Medicare & Medicaid Services Open Payments Program database for 2018. Consulting fee payments to physicians practicing in dermatology, internal medicine, neurosurgery, orthopedic surgery, otolaryngology, and plastic surgery were isolated and analyzed to identify discrepancies in consulting payments among these specialties and within plastic surgery.

RESULTS

A total of $250,518,240 was paid in consulting fees to specialties analyzed, with the largest average payment made to orthopedic surgeons and neurosurgeons. Nearly half of physicians were paid at least $5000 for consulting fees in 2018. Most payments were not associated with contextual information. Among U.S. plastic surgeons, 4.2% held financial relationships with corporations and were likely to be paid more when consulting for small companies.

CONCLUSIONS

Consulting payments make up a large proportion of payments included in the Open Payments Database. Although sex, state, company type, and sole proprietorship did not correlate with higher pay, plastic surgeons who consulted for small companies were paid more per payment than those working for large companies. Future studies are warranted to determine whether these industry financial relationships impact physician behavior.

Pharmaceutical Industry Payments to Diagnostic Radiologists

The Physician Payments Sunshine Act 2010 (PPSA) mandates that all industry payments to physicians be publicly recorded in order to increase transparency of industry-physician relationships. To assess industry relationships with diagnostic radiologists (DR), and to compare these relationships with those of oncology, a more directly medicine related field. We queried the Open payments database to collect industry payments data for both DR and oncology. Data was analyzed using IBM SPSS software, significance is set at P < 0.05. We found that from 2012 to 2020, a total of 178,957 industry payments to DR were made via cash in-kind items and services. The average value of a cash payment was $1529, and $223 for in-kind. In addition, we found that pharmaceutical industries contribute a large portion of industry payments to DR, with the top 3 payors being Merk Sharp and Dohme Corporation followed by Hologic and Pfizer. When comparing payments between DR and oncology, the latter received more total payments for each year until 2019, where after DR physicians began to receive more total value in payments. In addition, DR physicians received on average a 10 times greater payment per transaction. From 2012 to 2021, DR physicians have had a stable trend of number of payments received, but an increase in average value per payment. From 2019 to 2021, oncologists have observed a downtrend in total value of payments, while DR physicians are observing a steep uptrend. This investigation assesses industry payments to DR physicians with context added from those of oncology. The results show that pharmaceutical industry payors are significantly involved in radiology and DR physicians are receiving greater value of payments from industry sponsors. By increasing transparency of industry relationships and understanding the nature of these relationships, the impact of industry on patient care can be better understood.

Assessment of Financial Relationships Between Otorhinolaryngologists and Pharmaceutical Companies in Japan Between 2016 and 2019

INTRODUCTION

There are prevalent financial relationships between physicians and the pharmaceutical industry in medical specialties, including otorhinolaryngology. Although these relationships might cause conflicts of interest, no studies have assessed the size and contents of the financial relationships between otorhinolaryngologists and pharmaceutical companies in Japan. This study aims to evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese otolaryngologists and pharmaceutical companies.

METHODS

 Using payment data publicly disclosed by 92 pharmaceutical companies, we examined the size, prevalence, and trend in personal payments made to the otorhinolaryngologist board certified by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery (JSO-HNS) between 2016 and 2019 in Japan. Furthermore, differences in payments were evaluated by whether otolaryngologists were clinical practice guideline authors, society board members, and academic journal editors or not. Trends in payments were evaluated by generalized estimating equations.

RESULTS

 Of 8,190 otorhinolaryngologists, 3,667 (44.8%) were paid a total of $13,873,562, in payments for lecturing, consulting, and writing by 72 pharmaceutical companies between 2016 and 2019. The median four-year combined payment per physician was $1,022 (interquartile range: $473-$2,526). Top 1%, 5%, and 10% of otorhinolaryngologists received 42.3% (95% confidence interval (95% CI): 37.2%-47.4%), 69.3% (95% CI: 65.9%-72.8%), and 80.6% (95% CI: 78.3%-82.9%) of overall payments, respectively. The median payments per physician were significantly higher among otorhinolaryngologists authoring clinical practice guidelines ($11,522), society board members ($22,261), and journal editors ($35,143) than those without. The payments and number of otorhinolaryngologists receiving payments remained stable between 2016 and 2019.

CONCLUSION

 This study demonstrates that a minority but a large number of otorhinolaryngologists received personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing in Japan. Large amounts of these personal payments were significantly concentrated on a small number of leading otorhinolaryngologists.

Pharmaceutical Payments to Japanese Board‐Certified Head and Neck Surgeons Between 2016 and 2019

Objective

To evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese head and neck surgeons and pharmaceutical companies between 2016 and 2019.

Study Design

Cross-sectional analysis.

Setting

Japan.

Methods

This study evaluated personal payments concerning lecturing, consulting, and writing paid by 92 major pharmaceutical companies to all Japanese head and neck surgeons board-certified by the Japan Society for Head and Neck Surgery between 2016 and 2019. The payments were descriptively analyzed and payment trend were assessed using population-averaged generalized estimating equations. Further, the payments to board executive board members with specialist certification were also evaluated separately.

Results

Of all 443 board-certified head and neck surgeons in Japan, 365 (82.4%) received an average of $6443 (standard deviation: $12,875), while median payments were $2002 (interquartile ranges [IQR] $792-$4802). Executive board specialists with a voting right received much higher personal payments (median $26,013, IQR $12,747-$35,750) than the non-executive specialists (median $1926, IQR $765‒$4134, p < .001) and the executive board specialists without a voting right (median $4411, IQR $963-$5623, p = .015). The payments per specialist and prevalence of specialists with payments annually increased by 11.4% (95% CI: 5.8%-17.2%; p < .001) and 7.3% (95% CI: 3.8%-11.0%; p < .001), respectively.

Conclusion

There were increasingly widespread and growing financial relationships with pharmaceutical companies among head and neck surgeons in Japan, alongside of introduction of novel drugs. The leading head and neck surgeons received much higher personal payments from pharmaceutical companies, and no sufficient regulation was implemented by the society in Japan.

Industry Payments to Plastic Surgeons, 2013 to 2018: Who's Getting Paid?

BACKGROUND

The Physician Payments Sunshine Act of 2010 mandated that all industry payments to physicians be publicly disclosed. To date, industry support of plastic surgeons has not been longitudinally characterized. The authors seek to evaluate payment trends from 2013 to 2018 and characteristics across plastic surgeon recipients of industry payments.

METHODS

The authors cross-referenced those in the 2019 American Society of Plastic Surgeons member database with Centers for Medicare & Medicaid Services Open Payments database physician profile identification number indicating industry funds received within the study period. We categorized surgeons by years since American Board of Plastic Surgery certification, practice region, and academic affiliation.

RESULTS

A sum of $89,436,100 (247,614 payments) was received by 3855 plastic surgeons. The top 1 percent of earners (n = 39) by dollar amount received 52 percent of industry dollars to plastic surgeons; of these, nine (23 percent) were academic. Overall, 428 surgeons (11 percent) were academic and received comparable dollar amounts from industry as their nonacademic counterparts. Neither geographic location nor years of experience were independent predictors of payments received. The majority of individual transactions were for food and beverage, whereas the majority of industry dollars were typically for royalties or license.

CONCLUSIONS

Over half of all industry dollars transferred went to just 1 percent of American Society of Plastic Surgeons members receiving payments between 2013 and 2018. Considerable heterogeneity exists when accounting for payment subcategories.

Industry Payments to Adult Reconstruction-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019

BACKGROUND

In recent time, there has been an increased push toward transparency in industry funding toward physicians. The Physician Payments Sunshine Act called for the creation of the Open Payments Database managed by the Centers for Medicare & Medicaid Services. To our knowledge, there have been no studies evaluating the trends in payments among adult reconstruction fellowship-trained orthopedic surgeons. The purpose of this study is to investigate trends in all payments to adult reconstruction-trained orthopedic surgeons from 2014 to 2019. Secondary outcomes included evaluating trends in yearly subpayment categories, regional variations, as well as characterizing the top 5 industry companies.

METHODS

A review of the Centers for Medicare & Medicaid Services Open Payments Database was performed to identify all payments to adult reconstruction-trained orthopedic surgeons. A total of 94,265 payments were made to 4911 surgeons accounting for a total of $258,865,231.20 during the study period. Our primary outcome was to assess the trend in median payment per year to individual surgeons. Secondary outcomes included evaluating payment trends with respect to subtype, location as defined by United States Census regions, as well as specifics concerning the top 5 companies.

RESULTS

Over the study period, there was a nonsignificant increasing trend in median payment per surgeon (r = 0.49, P = .096). However, there was also a significantly increasing trend in the number of payments per year (r = 0.83, P = .014), as well as the number of surgeons receiving payments (r = 0.88, P = .019). With respect to subcategory payments, there were significantly increasing trends in the median payment per surgeon for education (1054%, r = 0.942, P < .001) and entertainment/food and beverage expenses (20.2%, r = 0.49, P = .020), as well as a significantly decreasing trend for median honoraria payments per surgeon (20.2%, r = -0.04, P = .005). No significant regional trends were identified. Of the top 5 companies, one demonstrated a significantly decreasing trend in median payment per surgeon (21.6%, r = -0.109, P < .001), whereas the others remained unchanged.

CONCLUSION

In this study, we found a nonsignificant increasing trend in payments to adult reconstruction-trained surgeons as well as an increasing number of surgeons receiving payments. There were increasing trends in median payment per surgeon for education and entertainment expenses, but a decreasing trend for honoraria payments. No significant regional trends were identified. The majority of the top 5 companies had nonsignificant trends in their payments. Further studies are needed to characterize the disclosure of payments and the impact of industry payments on clinical outcomes.

LEVEL OF EVIDENCE

IV.

Physicians payment in the United States between 2014 and 2018: An analysis of the CMS Open Payments database

The Open Payments database reports payments made to physicians by industry. Given the potential for financial conflicts of interest relating to patient outcomes, further scrutiny of these data is valuable. Therefore, the objective of this study was to analyze physician-industry relationships by specialty type, payment type, geospatial trend, and longitudinal trend between 2014-2018. We conducted an observational, retrospective data analysis of payments from the Open Payments database for licensed United States physicians listed in the National Plan & Provider Enumeration System (NPPES). Datasets from 2013-2018 were joined using the Python programming language. Aggregation and sub-setting by characteristics of interest was done in R to calculate means and frequencies of reported general physician payments from industry across different specialties, locations, timeframes, and payment types. Normalization was applied for numbers of physicians or payments. Geospatial statistical hot spot analysis was conducted in ArcGIS. 51.73 million payment records were analyzed. In total, 50,047,930 payments were issued to 771,113 allopathic or osteopathic physicians, representing $8,702,631,264 transferred from industry to physicians over the five-year period between 2014 and 2018. The mean payment amount was $179, with a standard deviation of $12,685. Variability in physicians' financial relationships with industry were apparent across specialties, regions, time, and payment type. A limited match rate between records in the NPPES and Open Payments databases may have resulted in selection bias of trends related to physician characteristics. Further research is necessary, particularly in the context of changing industry payment trends and public perceptions of the appropriateness of these relationships.

Non-research industry payments to pediatric otolaryngologists in 2018

OBJECTIVES

To characterize non-research industry payments to pediatric otolaryngologists in 2018.

STUDY DESIGN

Centers for Medicare and Medicaid Services Open Payments program was used to obtain all non-research industry payments to pediatric otolaryngology in 2018. Total payment amount information was obtained for years 2014-2017 for trend analysis. Descriptive statistics were used to analyze the data.

RESULTS

There were 1704 payments to pediatric otolaryngologists in 2018, totaling $163,716 with a median of $17.79. Of the total payments, 74.77% (1274 out of 1704) were under $50. Payments to 299 physicians were reported for 175 different products, the majority of which were associated with otitis media and sinus disease. The nature of the payments included 1579 ($57,120) towards food and beverage, 64 ($46,251) for travel and lodging, 29 ($39,688) for consulting services, 23 ($1075) for education, 4 ($7898) for royalty or license, and 5 ($11,684) for compensation for services such as serving as faculty or a speaker.

CONCLUSION

Our study is the first to investigate industry payments to pediatric otolaryngologists in 2018. Most of the payments were under $50 and mainly for food and beverage. The majority of payments were associated with otitis media and sinus disease.

Financial Transactions from Manufacturers to Otolaryngologists in 2018

OBJECTIVE

To characterize in depth non-research and research payments from industry to otolaryngologists in 2018 with an emphasis on product types.

METHODS

Centers for Medicare and Medicaid Services Open Payments program was used for data collection: payment amount, the nature of payments, products associated with the payments, date of the payments, and companies making the payments were studied. Products associated with the payments were classified by categorical type. Descriptive statistics were used to analyze the data.

RESULTS

There were 70,172 payments for a total of $11,001,875 made to otolaryngologists in 2018 with a median payment of $19. Food and beverage had the highest number of payments made (89.96%). Consulting fees (33.46%) composed the highest total payment amount. The two companies that contributed the highest amount were Stryker Corporation and Intersect ENT Inc. Sinus conditions had the most products within the top 25 products associated with payments. The top five products with the highest payments received were for balloon sinus dilation, nasal spray, sinus implant, Botox, and cochlear implant. There was a bimodal payment distribution demonstrating a higher number of payments made in the spring and fall.

CONCLUSION

Our study is the first to review payments to otolaryngologists in 2018 and classify these payments into product types. The products and companies that contributed the highest payments were associated with sinus conditions. The products that dominated in each subspecialty of otolaryngology coincide with clinical practice trends and emerging technologies.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E388-E394, 2021.

Nationwide patterns in industry payments to academic vascular surgeons

OBJECTIVE

Financial relationships between vascular surgeons and industry are essential to the development and adoption of innovative technology. However, these relationships may establish competing interests. Our objective was to describe publicly available financial transactions between industry and academic vascular surgeons.

METHODS

Academic vascular surgeons were identified and characterized on the basis of publicly available data correlated with Accreditation Council for Graduate Medical Education and Association of American Medical Colleges data to identify academic practice settings. Vascular surgeons were linked to Open Payments data for 2017 as reported by the Centers for Medicare & Medicaid Services. Univariate and nonparametric tests were used for analysis.

RESULTS

Of 1158 academic vascular surgeons identified, 997 (86%) received industry payments totaling $8,548,034. Overall, the median of total payments received was $814 (interquartile range [IQR], $124-$2863). The top paid decile of vascular surgeons received $29,645 (IQR, $16,128-$61,701). Payments to the top decile accounted for 81% of all payments. Payments did not vary by academic rank but did vary by sex, with male vascular surgeons (n = 954) receiving $889 (IQR, $146-$3217) vs female vascular surgeons (n = 204) receiving $467 (IQR, $87-$1533; P = .002). By leadership role, division chiefs received the highest median payment amount ($1571; IQR, $368-$11,281) compared with department chairs ($424; IQR, $56-$2698) and vascular surgeons without leadership role ($769; IQR, $117-$2592; P = .002). Differences in payments were also seen on the basis of U.S. census region: Northeast, $571 (IQR, $90-2462); Midwest, $590 (IQR, $75-$2364); South, $1085 (IQR, $241-$3405); and West, $1044 (IQR, $161-$4887; P = .001). The most common categories of payments were food and beverage (paid to 85% of all vascular surgeons), travel and lodging (35%), and consulting fees (13%). Among the top decile of vascular surgeons, median payments exceeded $10,000 for three categories: consulting fees, compensation, and honoraria. Payments were made by 178 distinct entities with median total payments of $286 (IQR, $70-$6285). The three top entities paid a total of $5,004,061, which accounted for 59% of all payments. Payments from at least one of the top three entities reached 76% of vascular surgeons.

CONCLUSIONS

Most academic vascular surgeons receive publicly reported industry payments that are paid by a limited number of entities, typically for food and beverage or travel and lodging. The top 10% of vascular surgeons received higher median payment amounts, totaling 81% of all industry payments. Vascular surgeons should be aware of publicly reported payment information and the potential for conflicts of interest.

Patterns of Industry Payments to Urologists From 2014-2018

OBJECTIVES

To evaluate the patterns of financial transaction between industry and urologists in the first 5 years of reporting in the Open Payments Program (OPP) by comparing transactions over time, between academic and nonacademic urologists, and by provider characteristics among academic urologists.

METHODS

The Center for Medicare & Medicaid Services OPP database was queried for General Payments to urologists from 2014-2018. Faculty at ACGME-accredited urology training programs were identified and characterized via publicly available websites. Industry transfers were analyzed by year, practice setting (academic vs nonacademic), provider characteristics, and AUA section. Payment nature and individual corporate contributions were also summarized.

RESULTS

A total of 12,521 urologists - representing 75% of the urology workforce in any given year - received $168 million from industry over the study period. There was no significant trend in payments by year (P = .162). Urologists received a median of $1602 over the study period, though 14% received >$10,000. Payment varied significantly by practice setting (P <.001), with nonacademic urologists receiving more but smaller payments than academic urologists. Among academic urologists, gender (P <.001), department chair status (P <.001), fellowship training (P <.001), and subspecialty (P <.001) were significantly associated with amount of payment from industry. Annual payments from industry varied significantly by AUA section.

CONCLUSION

Reporting of physician-industry transactions has not led to a sustained decline in transactions with urologists. Significant differences in industry interaction exist between academic and nonacademic urologists, and values transferred to academic urologists varied by gender, chair status, subspecialty, and AUA section.

Characteristics of Industry Payments to Ophthalmologists in the Open Payments Database

Importance

An increased awareness of the interactions between the medical industry and health care professionals may lead to lower health care costs and more effective health care practices.

Objective

To assess the characteristics of industry payments made to ophthalmologists between 2013 and 2017.

Design, Setting, and Participants

This analysis included data reported in the June 29, 2018, update of the Centers for Medicare & Medicaid Services Open Payments Database (OPD). The OPD contains public records of industry payments made to physicians and teaching hospitals from August 1, 2013, to December 31, 2017, as reported by the medical industry. All general or research payments distributed to US ophthalmologists and contained in the OPD were included in this study. Data are summarized by practitioner, manufacturer, payment category, and geographic location.

Main Outcomes and Measures

Main outcomes were the distribution, quantity, and value of payments made to ophthalmologists practicing in the United States or US territories. The financial characteristics of payment category, manufacturer, product, and location were also assessed.

Results

This analysis revealed that the OPD showed industry reporting a total of 20 943 ophthalmologists receiving 736 517 payments worth $543 679 603.53 (1.67% of all industry-reported funds in the OPD). The median payment value was $22.44. Most payments were for food and beverages (581 588 [78.96%]), whereas most funds were allocated toward research ($310 142 151.88 [57.05%]) and consulting fees ($73 565 327.71 [13.51%]). The median payout to each ophthalmologist was $637.75 (interquartile range, $167.33-$2065.54). California was the highest-grossing state, receiving $101 135 980.34 (18.60%) of all payments. Fifteen companies were responsible for 87.68% of all funds distributed ($476 719 470.11) and were mostly involved in the production of pharmaceutical agents (anti-vascular endothelial growth factor agents, glaucoma eyedrops, and ocular lubricants) and surgical devices (cataract and glaucoma).

Conclusions and Relevance

Although there is no way to know the veracity of these reports, the findings suggest the financial ophthalmologist-industry relationship is substantial. These relationships may be adding to health care costs and affecting the quality of care, although those associations were not evaluated in this study.