Update: CDC data say docs still making billions from Pharma, med device companies; my personal take.

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The News:

It’s been a few years since the US government unveiled its Open Payments (OP) database, a collection of drug and device makers’ payments to healthcare providers. The data-collection process itself–indeed, the very fact of its existence–triggered an avalanche of complaints, denials and hypercritical pickiness and pettiness.

Now, the OP database has become the subject of one more annual public report. The Centers for Medicare and Medicaid Services disclosed the 2016 numbers Friday, exactly one year from its report for 2015, says FiercePharma.

And despite some early predictions that transparency would change everything, for example, doctors would start turning away speaking fees, and drugmakers decrease the free meals and dinner, the numbers have remained eerily consistent.

Why eerily? Because despite the insinuation of impropriety, Pharma hasn’t stopped spending and doctors aren’t eshewing their largess. General payments, which include meals, speaking fees, consulting and such, came in at $2.68 billion in 2014.

2015: $2.68 billion.

2016: $2.8 billion.

The numbers of doctors who are participating in the Pharma munificence are astounding. The numerical amount of physicians–who are the primary target for Pharma’s one-on-one marketing–who collected nonresearch money totaled 625,000 in 2014.

2015: 632,000.

2016: 631,000.

Free food, travel and lodging, specifically, came in at $430 million in 2016, compared with $470 million in 2015.

What do all these numbers signify? They show who’s promoting which drugs to which doctors. Sometimes they can show what those payments yield.

Researchers and journalists have crunched the numbers together with other data, and some have found associations between the size of payments and physician prescription numbers. Last year, a JAMA study–disputed by some in biopharma–found an association between the number of free meals and the number of prescriptions for brands promoted at those meals, says FiercePharma.

The final tally of healthcare providers’ dollar ties to drug and device companies came in at almost $8.2 billion for 2016, including research funding, royalties and licensing, free meals, speaking fees, consulting payments and investment interests physicians hold in healthcare businesses. Research amounted to more than half that amount, leaving ownership and investment interests to make up the remaining $1.02 billion.

With 11 million records in this year’s database, there’s plenty to sort through. A fleeting look puts Allergan at the top of the Big Pharma pile with $66.4 million in general payments, with Sanofi (including Genzyme, $58.4 million), Celgene ($54.6 million), Valeant (including its Salix subsidiary, $53.1 million) and Biogen ($50 million) rounding out the highest-spending five.

Details on Pharma’s financial ties with doctors were first disclosed bit by bit, as part of marketing settlements with the US justice department. Eli Lilly, GlaxoSmithKline, AstraZeneca and Merck & Co. were among that group. The data-collection went wider–and became combined–with the Physician Payment Sunshine Act, part of the Affordable Care Act. The OP database is the first to cover all US drug and device companies.

Steve’s Take:

This most recent CDC report on drug and device maker generosity vis-à-vis doctors reminds me that the more some things change, the more they stay the same. The question is, is this a good or a bad thing?

The dollar amount of payments from Pharma to doctors fluctuated just 4% from 2014 to 2016–“insubstantial” by most financial accounting standards, although still rising, which is a concern.

Although we don’t yet have all the breakdowns, as for physicians, those receiving the highest payments in 2015 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 slightly to less than $26,100 in 2015.

A recent study, published in JAMA Internal Medicine (June 20, 2016) that I mentioned in a similar article last year, 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.

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.

Bottom Line:

I still don’t agree with the implication of wrongdoing (in the CDC data) among the vast majority of doctors.

I’m not buying the belief that the old adage, “there’s no such thing as a free lunch,” is as true today vis-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’m fortunate to have friends and colleagues who are representative of healthcare providers of the highest calling and skill. And I’ve come to my own personal conviction that they truly care first and foremost for each one of their patients.

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 Physiciansthe 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.

Steve's Take: Anyone who thinks doctors are influenced by free lunches is out to lunch Click To Tweet

As I said exactly a year ago, 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. Yes, there certainly are some really bad actors out there, as my recent piece on Insys points out.

But what I view as a dodgy campaign to denigrate healthcare professionals with such pettiness needs to be re-directed to far more important issues in our nation, today. Like who gets health care and who doesn’t.

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