We all want to feel confident in our doctor’s treatment recommendations. Certainly, we don’t want our doctors prescribing medications that will fatten their own wallet, instead of focusing on what medications will help us the most. Similarly, we don’t want our doctors recommending medical devices that are not in our best interest. Unfortunately, device and drug company payments influence doctors to recommend their products, which can harm patients.
Drug company payments influence doctors and create a clear conflict of interest.
The pharmaceutical and medical device industries spend billions of dollars every year marketing to doctors. Their marketing campaigns use gifts to ingratiate themselves to doctors in order to influence doctors’ recommendations.
This practice is common, despite widely accepted studies that demonstrate that industry’s marketing activities influence doctors’ behavior in ways that are detrimental to patients and the public.
How many doctors take industry payments?
One study analyzed data from the 2015 Open Payment System to determine the types and distribution of industry-related payments to US doctors. Alarmingly, approximately 48% of doctors received payments, totaling $2.4 billion.
Interestingly, 47.7% of primary care doctors received payments, compared to 61% of surgeons. And male doctors were more likely to receive payments than female doctors.
Alarmingly, even doctors disciplined for serious medical misconduct have received industry payments. For example, according to an NPR article, at least 400 pharmaceutical and medical device makers have made payments to doctors who were disciplined by their state medical boards, including those disciplined for severe offenses such as providing poor care, sexual misconduct, and inappropriately prescribing addictive medications.
What kinds of payments do doctors receive?
Payments include free meals and luxury vacations where doctors receive payments to serve as “consultants”. Additionally, doctors receive money for consulting and for giving promotional talks.
A ProPublica evaluation found that some doctors were paid thousands of dollars, often for promotional speaking. However, most doctors only received meals, usually valued at less than $100 per year.
Drug company payments influence doctors.
It’s alarming to think that your doctor may recommend a particular medication due to financial ties, even though a different medication may be more effective and/or less costly. But it’s common, potentially harmful, and expensive for patients.
For example, according to a STAT article, accepting pharmaceutical industry money has lead doctors to:
- Prescribe expensive, potentially worthless drugs.
- Prescribe more expensive brand-name drugs, instead of generics.
- Deviate from prescribing guidelines.
Ethical standards for pharmaceutical companies.
Years ago, the pharmaceutical industry provided expensive vacations and other luxuries to doctors. But, in 2002, the Pharmaceutical Research and Manufacturers of America created the PhRMA Code to dissuade pharmaceutical companies from giving US doctors financial incentives to prescribe particular medications.
An updated version of this voluntary code of ethics, effective January 1, 2022, includes the following guidelines:
- Company sponsored speaker programs must present substantive educational information. Attendance must be limited to doctors with a bona fide educational need for the information.
- The pharmaceutical company must offer only modest meals, with no alcohol. Educational programs should not be held at high-end restaurants.
Companies that agree to comply must submit annual certifications to PhRMA attesting that they have policies and procedures in place to foster compliance with the PhRMA Code.
Importantly, note that pharma companies can legally pay doctors, as long as the payments do not serve as inducements to get doctors to use or recommend a particular product.
Does PhRMA Code work as intended?
With these strict PhRMA Code limitations, how do companies manage to give billions of dollars each year to doctors and hospitals? Unfortunately, there is strong evidence that rules and fines don’t stop pharmaceutical companies from trying to influence doctors.
For example, a 2019 ProPublica analysis found that doctors who received payments linked to specific drugs prescribed more of those drugs. The study evaluated the 50 most-prescribed brand-name drugs in Medicare for which pharmaceutical companies had made payments to doctors in 2016. The results showed that on average, doctors who received payments prescribed 58% more of that drug than doctors who did not.
Similarly, researchers from Memorial Sloan Kettering Cancer Center published a report in 2021 confirming that industry cash influences how doctors treat their patients. The team analyzed 36 studies on the topic and found that each study showed that doctors prescribe more of a drug if they receive money from that drug’s manufacturer.
Additionally, a review of 2018 Open Payments records found that 139 medical oncologists received over $100,000 from by pharmaceutical companies in payments related to oncology-based drugs. Concerningly, 81% of these doctors hold leadership roles in hospitals or specialty associations, indicating they likely influence oncology practice and policy.
Interestingly, this practice was consistent across all medical specialties and types of drugs. For instance, the studies they reviewed show that pharmaceutical industry money affects how doctors prescribe the following medications:
- Cholesterol medications.
- Medications for Alzheimer’s disease.
- Drugs for multiple sclerosis.
- Blood thinners.
- Cancer treatments.
Alarmingly, another study found a link between the free meals offered by pharmaceutical companies and increased prescriptions. It turns out that a nice roast beef sandwich might be enough to influence your doctor!
Medical device companies are also guilty.
Similar to pharmaceutical companies, medical device companies also spend millions and millions to influence regulators, hospitals and doctors.
In fact, in 2017, the 10 largest medical device companies paid almost $600 million to US doctors and hospitals for consulting fees, research, travel, and entertainment fees.
Additionally, manufacturers of hardware for spinal implants, artificial knees, and hip joints paid more than $3.1 billion to orthopedic surgeons between August 2013 and December 2019.
Moreover, according to a KHN investigation, hundreds of orthopedists and neurosurgeons have lucrative stakes in companies that design, manufacture or distribute orthopedic implants. How? Device makers ask orthopedic surgeons for help designing or evaluating new devices, such as implants.
By offering feedback and helping with marketing efforts, doctors can earn millions from royalty fees, consulting work, and/or stock holdings. For instance, doctors can earn money every time a device is sold. And some surgeons own pieces of companies that buy implants from manufacturers and resell them at a profit.
The conflict of interest created from these partnerships occurs despite ongoing ethical and legal concerns. Can these financial incentives influence their treatment choices for their own patients? Seems likely to me!
It’s worth noting that doctors can legally work for, or own a piece of, a medical business as long as their compensation is not tied to the volume of its products they use. Additionally, they must make medical decisions in the best interests of their patients.
A dangerous example of device maker’s influence on medical decisions.
This frightening story began when Bernetta, a 65 year-old woman, went to a Los Angeles County hospital with abdominal pain in December 2013. A CT scan showed an aortic dissection – a life-threatening condition involving a tear in the main artery. If the aorta ruptures, the patient can die. However, the tear can also heal on its own.
Since surgery to repair the problem has a high risk of stroke, paralysis, and death, medical guidelines dictate that surgery be avoided if the tear is healing and the pain has subsided. Dr. Timothy Ryan, a surgeon handling her case, felt the dissection was healing and didn’t recommend surgery. Bernetta went home less than a week later with no pain.
While in the hospital, surgeon Dr. Rodney White told her about an experimental surgery that would take care of a tear in her aorta’s lining. After she returned home, Dr. White contacted her and told her to return to the emergency room. He told her to tell the staff she had chest pain, even though she didn’t. She went to the ER as instructed.
Dr. White admitted her, writing in her records that she “woke up early this morning with chest pain … accompanied by nausea and dizziness.” Furthermore, he wrote that Bernetta called his office and his staff “instructed her to go to the ER.” Importantly, Bernetta reports that none of that is true.
Four days later, Dr. White implanted two $15,000 medical devices. Importantly, Dr. White and his partner were both on the payroll of Medtronic, the company that makes the devices implanted in her surgery.
Unfortunately, Bernetta suffered a stroke during the procedure. To recover, she spent a month at the hospital, and two months at a rehab facility, learning to talk again and do simple, everyday tasks.
A whistleblower lawsuit blames Medtronic’s payment to the surgeons.
Dr. Ryan filed a whistleblower lawsuit, claiming medical guidelines did not indicate that Bernetta needed these devices. Furthermore, Dr. Ryan claimed that surgeons searched patient charts to find candidates for the expensive devices, even if they didn’t need them. In March 2022, a jury awarded Dr. Ryan $2.1 million, agreeing that county officials retaliated against him after he “blew the whistle”.
Additionally, Dr. Ryan filed an appeal stating that the judge limited how much the jury could award him. In December, a judge ordered the country to pay $3.2 million to cover Dr. Ryan’s legal bills. Unsurprisingly, the county is appealing that decision as well as the jury’s verdict.
The experimental surgery on Bernetta, who is Black, was part of an extensive research program at this county hospital, a facility that mostly serves low-income patients of color.
For more information on this disturbing story, read the Los Angeles Times article.
Why does this matter?
Industry whistleblowers and government investigators say these payments “can corrupt medical judgment and tempt surgeons to perform unnecessary and wasteful operations”.
For more information on the problematic partnerships between medical device companies and surgeons, read the KHN article here.
And for more information on medical devices in general, read How Safe are Medical Devices?
What do doctors say about these payments?
The majority of doctors believe that accepting industry payments is appropriate, and do not influence which medications they prescribe. But studies show that doctors who accept the most money from pharmaceutical companies also prescribe the most of those companies’ medications.
Doctors claim they rely on sales reps to educate them on new products. However, sales reps often provide a catered lunch alongside the information on new medications. And although a catered lunch seems like a minimal payment, as we saw above, meals can influence doctors’ prescribing habits.
Moreover, research shows that product information received by industry reps is biased, which can lead to less than optimal treatment decisions. Importantly, doctors can find information on new medications from other sources, such as medical professional societies.
Additionally, doctors claim their work as paid consultants helps in the development of new medications. Although this could be true, pharmaceutical companies pay doctors $2 billion each year to persuade them to prescribe medications already available, not to work on new drug development.
Interestingly, many doctors insist they can manage these financial conflicts of interest by simply disclosing them and by “being honest”. But, there have been no well-conducted studies to support the effectiveness of disclosure and honesty.
Does your doctor receive device or drug company payments that could influence their treatment decisions?
Importantly, pharmaceutical and medical device companies must release details of payments made to doctors and US teaching hospitals. This includes payments for promotional talks, research and consulting, and other categories.
Fortunately, you can look up your doctors to learn if they accept device or drug company payments, using:
What else can you do about the influence of device and drug company payments?
If you have a serious medical condition, it’s always a good idea to get a second, or even third, opinion. Another opinion can confirm a recommended treatment course or reveal alternative options.
Because medicine is part science and part art, I recommend you get a second opinion even if your doctor has no financial ties to industry.
For more information, Why are Second Opinions Important?
In addition to concerns about the influence device and drug company payments have on doctors, all medications and medical devices can cause harm. To reduce your risk of harm, read these posts:
- What’s an Adverse Drug Reaction?
- Reduce Your Risk of Medication Errors.
- Dangers of Black-Market Medications – More Common Than you Think.
- Doctors Prescribe Too Many Medications.
- Are Medications Safe?
- The Dangers of Too Many Medical Tests and Treatments.
NOTE: I updated this post on 3-9-23.