U.S. Doctors, Hospitals Receive Billions from Drug, Device Makers; Report

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Drug and device makers sustained their payments to doctors and teaching hospitals at nearly $6.5 billion last year, according to the figures released Thursday from a federal database. And physicians or their family members held $1 billion in ownership or investment interest in those companies.

Novartis AG (Basel CHE) topped the list with more than $539 million reported in payments to healthcare providers, a big jump from $302 million in 2014, according to the Open Payments database maintained by the U.S. Centers for Medicaid & Medicare Services.

Next was Genentech Inc. (South San Francisco), which reported $470.3 million. In 2014, Genentech led the pack at nearly $385 million. In third place was Pfizer Inc. (New York City), with more than $436 million, although the company filed the largest number of reports.

However, figures for ownership and investment interests were not available. Publicly held companies are not required to report ownership and investment interests, according to the CMS.

As for physicians, those receiving the highest payments were doctors in nuclear medicine. They received average payments of more than $51,200, followed by neurological surgeons, whose average payments were $26,100. In 2014, orthopedic surgeons received the highest average payment, which was nearly $34,600, but that fell to slightly to less than $26,100 last year.

The database was created under the Sunshine Act provision of the Affordable Care Act in response to concerns that industry payments to doctors might unduly influence medical practice and research. Drug and device makers are required to provide data to Open Payments, which was launched in September 2014. The database initially covered part of 2013 and all of 2014.

On Thursday, however, CMS provided 2015 transaction data for the first time. At a number of community hospitals, well more than half of the affiliated doctors were beneficiaries of payments, according to a new analysis. Overall, CMS said drug and device makers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals. The agency counted 11.9 million total records attributable to nearly 619,000 physicians and more than 1,100 teaching hospitals.

The week prior, a new study in JAMA Internal Medicine suggests that doctors who get a free lunch from drug company representatives are more likely to prescribe the company’s costly medications. The study covered Medicare prescriptions in for drug classes: statins, beta blocker heart medicines, ACE and ARB blood pressure pills and SSRI-type antidepressants.

The conclusion of the study was that brand name drugs were favored after a drug company-sponsored meal of less than $20. If the meal cost more than $20 or if there were more than one meal involved, the brand name medications that were being promoted were even more likely to be prescribed over less costly generics.

Steve’s Take: As this particular article points out, a recent new study published in JAMA Internal Medicine (June 20, 2016) suggests that doctors who get a free lunch from drug company representatives are more likely to prescribe the company’s costly medications.

Another article in JAMA Internal Medicine (May 11, 2009) demonstrated that fourth-year medical students: “exposed to Lipitor promotional items had more favorable implicit attitudes about the brand-name drug compared to the control group…” These and other articles clearly imply that even small favors like a $16 lunch, may have an impact on practicing physicians, and they should know better!

I’m just not buying this notion that the old adage, “there’s no such thing as a free lunch,” is as true today viv-a-vis doctors as it was back in the 19th century when bars gave their customers a free lunch in exchange for buying a drink or two.

I consider myself fortunate to have many friends and colleagues who are MDs, DMs and DOs. And I’ve come to my own personal conviction that they truly care for each one of their patients, first and foremost. I’ve tried to imagine the scenario wherein a doctor, who upon diagnosing a patient’s illness, suddenly stops and thinks: “Aha! Here’s my chance to prescribe XYZ Pharma company’s heart medicine in return for that really exquisite Reuben sandwich last week.”

According to a 2013 survey by the American Academy of Family Physicians, the average member of that group had 93.2 “patient encounters” each week–in an office, hospital or nursing home, on a house call or via an e-visit. That’s about 19 patients per day.

Anyone who thinks doctors have the time, let alone the inclination, to formulate their patient prescribing choices based upon free lunches is out to lunch, in my opinion. What I view as a sleazy campaign to denigrate healthcare professionals with such pettiness needs to be re-directed to far more important issues in our sector today.