A Case of Torn Loyalty? Industry Rewards and Payments to Gastroenterologists

Abstract

Introduction: Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. Choosing the medical specialty of gastroenterology, we examined the nature and amounts of monetary and other benefits that physicians received more than a decade after many institutions implemented conflict of interest policies. Methods: We analyzed information from the Open Payments database (https://www.cms.gov/openpayments/), including all reports about payments that pharmaceutical and device manufacturers or group purchasing organizations gave to adult or pediatric gastroenterologists in 2016. Using PubMed, we examined the professional affiliations and publication records of top payment recipients and identified panelists of clinical guidelines who also received personal financial rewards, listed in the Open Payments database. Results: A total of 432463 payments went to 13467 individuals and accounted for a total expenditure of $67,144,862. Nearly 90% of the submissions were related to food and beverages. Direct financial payments for consultations, talks, or other services were made to 2055 physicians (13.2%) and were responsible for 4•1% payments, but for 62•7% of the total expenditures. Ten products were linked to 63•8% of payments related to direct financial rewards and 59•1% of the total expenditures. Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts listed in the Open Payments database exceeding $10,000 in one third of them. Conclusion: Most gastroenterologists accept meals or gifts from industry, with one in seven receiving direct payments. 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.1087_A Figure 1. Relative distribution of payments by nature of rewards1087_B Figure 2. Relative distribution of direct financial rewards paid by industry sources1087_C Figure 3. The ten most common drugs linked to payments, as reported in the Open Payments Database