In early coal mining, miners would keep a canary in the mine as an early warning system for lack of oxygen. An early warning that development of new pharmaceuticals and devices is waning, is the decline of relationships that physicians have with industry in developing and commercializing these products. A new study shows significant decrease in all of the physician industry relationships.
Eric Campbell, PhD, of the Mongan IHP, and a strong critic of physician-industry collaboration, recently published an article in the Archives of Internal Medicine entitled, “Physician Professionalism and Changes in Physician-Industry Relationships From 2004 to 2009.” The Institute for Medicine as a Profession sponsored the study, which paid participants $20 to answer the survey.
In 2004, members of the same research team published the first national survey of physician-industry relationships, in which 94 percent of respondents reported at least one type of drug industry relationship. The 2004 study showed that receiving prescription samples or food in the workplace was reported most frequently, and reimbursement for the costs of medical meetings or continuing education, as well as speaking and consulting fees, were common.
In publishing this year’s data, Dr. Campbell noted that while “physician-industry relationships have decreased significantly since 2004, they are still found among more than three-quarters of those responding to our survey.” He asserted that based on “the persistence of industry’s substantial financial interaction with U.S. physicians, there is a need for a nationwide system to publicly report these relationships.”
Such a system already exists, or at least is in the stages of creation and implementation. The Sunshine Physician Payments Act, which was included in the Affordable Care Act, will require all drug and device companies to report all such relationships starting in 2013. Many companies have already begun publishing these payments as well.
2010 Survey Findings
The national survey included a stratified random sample of 2938 primary care physicians (internal medicine, family practice, and pediatrics) and specialists (cardiology, general surgery, psychiatry, and anesthesiology). A total of 1891 physicians completed the survey, yielding an overall response rate of 64.4%. The main outcome measure was prevalence of several types of physician industry relationships (PIRs) and comparison with PIRs in 2004.
The results of the study showed overall, 83.8% of all respondents reported some type of relationship with industry during the previous year, a 10% decline from 94% in 2004. Of those with PIRs:
– 63.8% received drug samples, down from 78% in 2004
– 70.8% food and beverages, down from 83% in 2004
– 18.3% reimbursements, including CME, down from 35% in 2004
– 14.1% percent said they had been given payments for serving on advisory boards and enrolling patients in clinical trials, compared to 28% in 2004
The study also found that the number of meetings respondents reported having with pharmaceutical company representatives dropped from an average of three a month to two; a change the authors note could reflect greater pressures on physicians’ time as well as institutional policy changes.
Cardiologists were most likely to report industry relationships, while psychiatrists—a specialty not included in the earlier survey—were the least likely. Physicians in solo, two-person or group practices were more likely to receive drug samples, meeting reimbursements or gifts than those in hospitals and medical schools; but academically based physicians were most likely to receive payments for speaking, consulting or serving on advisory boards.
The 2010 survey included a new question asking how often physicians had prescribed a brand name drug when an equivalent generic was also available. Overall, respondents with industry relationships were more likely to self-report prescribing the more expensive drugs. This finding should have no significance given that over 75% of prescription medications are generic. The study also found that physician-industry relationships were reported more frequently in regions with higher health costs.
One problem with the findings associated with costs is that the survey only included 20.9% of physicians who practiced in low-cost regions. In other words, it should come as no surprise that respondents had more relationships in regions with higher costs because 80% of respondents were from medium or high cost regions. A different result may have been attained had the survey sample been more balanced.
Moreover, measuring brand name drugs in reference to health care costs must also take into account various factors such as formularies or the types of patients a particular doctor sees. An oncologist, who is treating patients with new clinical trials and treatments will have only limited choices, all of which are very expensive, whereas a primary care physician may have less complicated treatments to prescribe for. Additionally, the study does not take into account the fact that a patient may want a particular treatment, or other options have not been successful.
Nevertheless, Campbell asserted that this finding indicated a significant association between physician-industry relationships and the use of more expensive drugs, suggesting that future investigations of factors underlying high-cost medicine should explore the possible driving role of these relationships.” He also maintained that the “influence of industry continues to be prevalent and powerful.” So what exactly is wrong with that?
This study failed to show any evidence of how PIRs affect patient outcomes. Was there any harm to patients from physicians who took free samples or meals? Was there a worse or better outcome among patients whose physicians consulted or spoke for industry? Evidence of this was not gathered nor discussed, as could be expected since most anti-industry studies never include an objective analysis about the benefits of collaborating with industry.
Consequently, although the landscape of PIRs has changed significantly since 2004, at the institutional, state, and national levels, it is clear that many physicians still value their work and collaboration with industry. Dr. Campbell’s study was merely an attempt to show how strict conflict of interest policies, gift bans, and transparency or disclosure requirements have hindered industry-physician collaboration. Given Campbell’s criticism of PIRs, his analysis of course stands for the belief that less PIRs is a good thing. His position is misplaced given that no evidence to date has shown any harm to patients from PIRs.
Ultimately, contrary to what Campbell and others have tried to show for years, physician-industry relationships have created a long list of devices, treatments, drugs, vaccines, procedures, and numerous other advances in the last several decades. Without these advances, our life spans would be shorter, people would be in more pain and suffering, and our survival rates for deadly diseases such as cancer and heart disease would be much worse. Moreover, it is because of industry-physician relationships that patients that have chronic diseases are able to control their symptoms and manage their lives accordingly.
While there have been questionable practices in the past, most of them occur with the marketing of such products, and not the physician-industry relationship responsible for the creation and discovery of such breakthroughs. Given the new transparency measures in place, and new policies on disclosure and innovation management, there should be less concern about such relationships because the motivation of doctors and industrial partners are the same: improving the health of patients.