In addition to the recent BMJ study about endocrinologists, cardiologists, and hematologists, another study was recently written about ophthalmologists and a purported association between reported industry payments and physician-prescribing habits. This study, published by JAMA Ophthalmology, compared the use of anti-vascular endothelial growth factor (VEGF) intravitreal injections by United States ophthalmologists to industry payments those same physicians received.
Once again, the authors behind the study acknowledged that “Although the data can’t confirm a cause and effect, [they] found a positive association between reported pharmaceutical payments and increased use of drugs prescribed to treat problems of the retina.”
This study reviewed data from the Centers for Medicare and Medicaid Services (CMS) 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File and the CMS-sponsored August through December 2013 Open Payments Program. Ophthalmologists who prescribe anti-VEGF injections for all indications were analyzed.
The findings of the study were that a total of 3011 United States ophthalmologists were reimbursed by CMS for 2.2 million anti-VEGF injections in 2013 and, of those physicians, 38% reportedly received $1.3 million in industry payments for ranibizumab and aflibercept. According to the authors, further analysis “revealed positive associations between increasing numbers of reported industry payments and total injection use, aflibercept and ranibizumab injection use, and percentage of injections per physician that were aflibercept or ranibizumab.”
Additionally, subgroup analysis further revealed that physicians who received between $1 and $25 in reported industry benefits were more likely than those not receiving industry payments to perform a greater percentage of their injections with aflibercept and ranibizumab.
According to Rajendra S. Apte, PhD, MD, the Paul A. Cibis Distinguished Professor of Ophthalmology & Visual Sciences at Washington University, “There has been a lot of interest in the associations between industry payments and physician behavior, but the scientific data that would allow us to tease out those relationships have not been available to the extent that the information is available now.” However, Dr. Apte also noted, “I’m not willing to draw conclusions about causality, but there is an association between contacts with industry and prescribing patterns.”
Why Do We Harp On This?
This is the second very-recent study that attempts to call physicians and industry representatives out for “working together” and linking payments received by industry to physician prescribing practices. While continuing to purport such a link may seem harmless, what is actually does is sow unnecessary (and unearned) distrust between patients and their physicians.
Especially true in the case of ophthalmologists, what these researchers tend to ignore is that when physicians meet with industry representatives – whether it be over lunch, at a seminar, or in some other capacity – these physicians are learning about new treatments: new treatments that could very well help patients who have so far been unresponsive to any treatment.
Newer drugs in the ophthalmology field are among some of the most amazing. Take for example, diseases such as age related macular degeneration (AMD), which was a sentence of total blindness seven years ago. Thanks to new treatments, however, AMD is now a manageable disease with the right care.