Physician-industry Relationship Research Articles

Trends in Industry Payments to Surgeons During COVID-19

IntroductionThe Physician Payment Sunshine Act created the Open Payments Program (OPP), which is used to disclose transactions between physicians and industry. The impact of the coronavirus disease (COVID-19) pandemic on this relationship is yet to be determined. Our aim was to compare payments before and after the onset of COVID-19 through the OPP. MethodsThe OPP database was queried between 2014 and 2021 for all general surgery specialties. Payments were classified as general payments and research payments. Payments during 2014-2019 were classified as pre-COVID and compared to payments from 2020 to 2021 which were classified as post-COVID-Outbreak. ResultsFrom 2014 to 2021, 60,245 surgeons received general payments totaling $1.16 billion dollars. Comparing 2019 to 2020, general payments declined from $204.6 million to $108.5 million (−47%) and research payments from $157.3 million to $115.7 million (−26.5%). When comparing trends from 2014-2019 to 2020-2021, the mean number of payments was significantly higher at 394,782 versus 240,778 (P = 0.03) for general payments and 13,671 versus 10,382 (P = 0.03) for research payments. When comparing general payments among various surgical subspecialties, all fields saw a notable decline in general payments. Travel/lodging was the category of payment that saw the most significant change. ConclusionsIndustry payments declined as we entered the COVID-19 pandemic for both general and research payments. This decrease was seen across all surgical subspecialties. These trends in payments seen during the COVID-19 pandemic and the long-term economic impact of COVID-19 on the physician-industry relationship are still developing. Ongoing changes in future years to industry payments are worthy of continued monitoring.

New interaction modalities between the pharmaceutical industry and physicians

Due to sanitary restrictions secondary to the COVID-19 pandemic, various interactions between the pharmaceutical industry and physicians have changed. One of them has been the method for promoting medicinal products through academic meetings around diseases of financial interest. A recent modality has been unilateral promotion by the pharmaceutical industry through academic events with the invitation of so-called "experts" for the promotion of a specific drug. These meetings are often biased not towards optimal care of a disease, but rather towards commercial promotion of a specific drug, which may or may not be the best option, without considering associated therapeutic alternatives. The Committee of Ethics and Transparency in the Physician-Industry Relationship, of the National Academy of Medicine, analyzes this new circumstance and proposes some considerations to the medical community.

Recommendations for the sale and promotion of dermocosmetic treatments at the office.

A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Conflicts of interest in medicine. CETREMI recommendations.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Conflictos de intereses en medicina. Recomendaciones del CETREMI.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Libertad de prescripción médica.

Doctors require flexibility for prescription. However, some limits are laid down both by current knowledge and by restrictions imposed by access and rules and regulations. The Committee for Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine proposes several suggestions to help patients, which include the selection of the best alternatives for each case, formalization of prescription standards variations (doses, drug indications, etc.) written down in the medical records, and avoidance of fashions, untested novelties, argumentations solely based on advertising or commercial promotion and conflicts of interest.

Leaders in Urologic Education and Their Relationship to Industry: An Analysis of Sunshine Act Open Payments From 2014-2016

To examine trends in the financial relationship between biomedical companies and leaders in urologic education during the first 3 full calendar years since implementation of the Sunshine Act. All accredited American Urological Association (AUA) residency programs were identified using the AUA website. Urology program directors and department chairs of the affiliated institutions were identified using residency program or urology department websites. Urology journal editors who practice in the United States were identified using the SCImago Journal & Country Rank website. All identified individuals were categorized by urologic subspecialty and AUA region based on information stated on their corresponding websites. Payment data for each individual from 2014 to 2016 was accessed using the Centers for Medicare and Medicaid Services Open Payments website, and statistical analyses were performed to elucidate trends based on leadership position, urologic specialty, AUA region, payment type, and overall payments over time. Out of the 239 urologists identified, 85%, 78%, and 91% received some sort of payment in 2014, 2015, and 2016, respectively. Department chairs accepted payments more readily than program directors and journal editors in all years. Average total payments for all urologists increased yearly, with mean general payments trending down and mean research payments trending up. The Sunshine Act was passed in part to promote transparency of the physician-industry relationship. Though the proportion of urologic leaders accepting payments between 2014 and 2016 did not change significantly, increased public scrutiny could have contributed to the decrease in yearly general payments and the increase in yearly research payments.

El consentimiento informado: recomendaciones para su documentación

Informed consent is an indispensable element to obtain adequate patient participation either in research protocols or in therapeutic design. The Committee of Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine developed several recommendations for informed consent to be documented.

Recomendaciones a los cuerpos directivos de las agrupaciones médicas en su relación con la industria

Continuing medical education activities are often financially supported by pharmaceutical and device companies. With the purpose to ensure ethics and accountability in the management of this assistance, the Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico formulates recommendations to medical associations' leaders in this text.

Attitudes and relationship between physicians and the pharmaceutical industry in a public general hospital in Lima, Peru.

BackgroundThe interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists.ObjectiveTo describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru.DesignDescriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale.Results155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%), promotional material (87.8%) and attending meetings in restaurants (81.8%). Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found.ConclusionsA close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received and ethically accepted benefit. The attitudes of physicians on the ethical standards of acceptance of medical samples and other benefits are closely related with their exposure to the pharmaceutical industry. Future studies could explore the motivations of physicians working in resource-poor settings to maintain a close relationship with industry.

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

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. 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. 2008 Health Tracking Physician Survey. 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. 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.

2561 – A national survey of physician-industry relationship in saudi arabia

Relationships between physicians and pharmaceutical & other medically related industries have received considerable attention in recent years. We surveyed physicians all around Saudi Arabia (SA) to collect information about their knowledge, behaviors and attitudes regarding their relationships with the industry. A cross-sectional survey that used a 47-item, anonymous, self-administered questionnaire, was sent to all accessible doctors in SA. The questionnaire was developed based on literature review, discussed between authors and reviewed by experts. The survey 600 doctors (physicians and surgeons), 15% of them were psychiatrists who filled in the survey. Preliminary results of only 15% of the total sample indicated that 40.9% (n = 38) of participants have encountered a pharmaceutical company representatives (PRs) at least once in their life. Psychiatrists were among the top specialties in accepting gifts and promotions presented to them by PRs. 4.3% (n = 4) of participants mentioned that PRs almost always offer a gift and promotion after every meeting. The most frequently mentioned gifts presented to participants by PRs are stationary such as pens or notepads (26.9%). Although 60.2% (n = 56) of participants had been educated about the ethics in physician industry relationships, 34.4% of participants accept gifts and promotions presented to them by PRs. The final results of this study will be ready by Feb 2013. It will be presented fully in the EPA 2013. The results of this survey indicate that relationships between physicians and industry are common and underscore the variation among such relationships according to specialty, practice type, and professional activities.

Relationship between physician and industry in Aragon (Spain)

ObjectiveTo describe the relationship between industry and physicians and to analyze the physician characteristics associated with the probability of receiving benefits from industry in Aragon (Spain). MethodsWe carried out an observational, cross-sectional study in which Aragonese physicians (north-east region in Spain) from public and private settings completed an anonymous questionnaire on a web page between June and November 2008. Visits/month with industry, samples, gifts, reimbursements and payments were used as dependant variables in the regression analyses. Year of medical license, specialty, work setting, time spent on direct care, articles read/month and being a resident's tutor were used as independent variables. ResultsA total of 659 questionnaires were considered valid for the analysis. Overall, 87% (n=573) of the respondents reported they had received some benefit in the previous year and 90.1% (n=593) reported having held meetings with industry representatives monthly. Non-clinical specialists received fewer gifts (odds ratio [OR]=0.38; 95% confidence interval [95%CI]: 0.18-0.77), reimbursements (OR=0.14; 95%CI: 0.06-0.35) and payments (OR=0.30; 95%CI: 0.13-0.74) than their clinical colleagues. The probability of receiving reimbursements (OR=0.37; 95%CI: 0.15-0.89) and payments (OR=0.39; 95%CI: 0.20-0.77) was lower in primary care physicians. ConclusionsThis study, performed in a sample of physicians from a southern European region, demonstrates differences in the intensity of the physician-industry relationship depending on physician specialty and work setting. These results provide important information for improving transparency and for future research on the appropriateness and efficiency of prescription in Spain and other countries with similar health systems.

New paradigms for physician-industry relations: Overview and application for SVS members

Relationships between physicians and their industry partners have ranged from spectacular collaborations that produce extraordinary advances in patient care, such as endovascular aneurysm repair, to humiliating scandals such as extravagant trips and bogus "consulting" agreements resulting in legal actions. It is the latter which have led many to call for the end of all physician-industry relationships, and the former which mandate their preservation. While these two examples are representative of extremes at each end of the spectrum of this issue, in reality the majority of physician-industry relationships are far more complex, and the line between appropriate and inappropriate, and ethical and unethical, is hard to draw. The benefits of our relationships with industry are many: partnering to develop new therapies and technologies, educating and training physicians around new therapies and technologies, support of continuing medical education (CME), fellowship training, and patient education. The pitfall and danger of this relationship is that support from industry, be it a meal, a pen, an educational grant, or flattery, may unduly and inappropriately influence physician decision making around a specific company's product. While it is clear that free trips are not within the realm of proper interaction, what about unrestricted educational grants to institutions, or support of CME activities, professional society meetings, and new device training? As a result of the intense scrutiny of relationships between physicians and industry recently, multiple diverse entities (Association of American Medical Colleges, American Medical Association, Accreditation Council for Continuing Medical Education, professional medical associations, academic medical centers, industry, and government) have generated guidelines and policies with very different perspectives, reflective of their different missions. These policies range from vague and lenient, with only basic limitation of the physician-industry relationship, to extremely rigid and strict, with only minimal interaction and mission support permitted. Given the many changes in oversight and expectations for the relationship between physicians and industry, it is important for vascular surgeons to be aware of the background behind these modifications, the evidence that they are needed, and the positions of the diverse organizations and institutions that have already defined their policies on this issue.

A Review of the Federal Guidelines That Inform and Influence Relationships Between Physicians and Industry

The effective delivery and continued advancement of health care is critically dependent on the relationship between physicians and industry. The private sector accounts for 60% of the funding for clinical research and more than 50% of the funding sources for physician education. The nature of the physician-industry relationship and the role of the physician as a gatekeeper for health care make this association vulnerable to abuse if certain safeguards are not observed. This article will review the current federal guidelines that affect the physician-industry relationship and highlight several illustrative cases to show how the potential for abuse can subvert this relationship. The recommendations and "safe harbors" that have been designed to guide business relationships in health care are discussed.

The Physician-Industry Relationship: Lessons from the Minnesota Experience

Excellent patient care requires a healthy patient-physician working relationship. It also requires a healthy working relationship between physicians and every third party that participates in health care delivery. These third parties include payers, regulatory agencies, public health agencies, academic institutions, independent research organizations, biotechnology companies, and pharmaceutical companies.

Conflicto de intereses en la práctica clínica: Análisis ético de algunas relaciones con la industria

Sometimes, the prescription practice of physicians can be influenced by factors that are not related to scientific evidence due to the appearance of several conflicts of interest. These conflicts cause social concern and have prompted actions to regulate the ethics of individual and corporative activities related to healthcare. We analyzed the ethical problems involved in the physician-industry relationship. For this purpose, we considered as the main actors related to this problem, the pharmaceutical industry and their marketing strategies, medical doctors and the independence and objectivity that should guide prescriptions and, finally, patients and their right to receive prescriptions based on scientific evidence. From the point of view of the Bioethics principles, Beneficence would not be respected when gifts or other donations received from the industry affect doctor's independence. Non Maleficence principle could be jeopardized if there is an increased risk of treatment failure and finally Justice could be altered if there is a cost increase for either patients or health institutions. As a conclusion, we consider that the presence of conflicts of interest in the relationship of physicians with the pharmaceutical industry is an important ethical problem. In consequence, this group endorses the recommendations of the Chilean Association of Medical Scientific Societies and advices to include ethical guidelines on this topic in the curriculum of medical schools.

The pipeline and the porcupine: alternate metaphors of the physician–industry relationship

Industry and medicine share a complicated relationship that engenders a considerable degree of controversy. Although they share a relationship, industry and medicine have different perspectives toward their involvement with each other. Industry conceives of medicine as one aspect of the “drug pipeline”, a larger set of relationships that is necessary for producing and marketing products. In contrast, select physicians refer to medicine's relationship with industry as “dancing with the porcupine”, an inherently difficult and dangerous activity. This paper compares the “pipeline” and “porcupine” metaphors, and draws upon ethnographic data from fieldwork conducted among clinical neuroscientists at a Canadian medical school to further elucidate the perspectives of physicians toward industry and the nature of the physician–industry relationship. The paper argues that the physician–industry relationship is akin to a type of gift-exchange known as a total prestation, and that this form of total prestation is part of a strategy of capital reconversion.