Although Big Pharma has taken deserved heat for selling its drugs by slathering doctors with cheesy tchotchkes, lavish or even cheap meals, and pricey trips, as well as lucrative consulting and speaking opportunities, medical device-makers’ physician-payment programs also should get a tougher, deeper look.
That’s because device manufacturers paid doctors $3.62 billion in the years 2014–17 — 1.7% of the revenue in their business sector and more than seven times the percentage of drug industry revenue spent on payments to MDs, according to a new study published in the respected medical journal Health Affairs.
The payments have come under increasing fire, as even the smallest sums — yes, even for a slice of pizza and a beer or a few sodas — may sway doctors in prescribing drugs or favoring treatments, notably with certain medical devices. The sketchy product-promotion spending may not benefit patients and may boost health care costs, a growing body of evidence from studies is showing.
The East Coast health economics experts, basing their work on Medicare data, found that Big Pharma and device makers in many ways made similar kinds of payments to doctors, especially with lower-cost meal or beverage buys. The drug-promoting crowd dished out these perks, to about half the doctors it made payments to, amounting to a little under 1 in 5 of every dollar spent on MDs. That compared with device makers spreading around such payments to a third of physicians and 7% the total industry spend.
Both pharma and device makers “paid a nearly equivalent total dollar amount in consulting fees, although [those] by drug vendors were distributed to more than double the number of physicians.”
Device makers, diverging sharply from Big Pharma, spent about half of their sizable chunk of money on doctors for training and activities deemed as “innovation,” typically royalties for products likely developed with physicians, based on their knowledge and experience, the researchers found.
They noted that fewer doctors received the sums, and the recipients were dominated by specialists, not only in areas like neurology, urology, cardiology, endocrinology, and obstetrics-gynecology, but also in surgical practices (neurosurgery and general surgery.)
The device makers who pay out the most to doctors also is worth noting, the researchers reported:
“Ten firms (and their subsidiaries) accounted for 65% of device-related general payments to physicians over the course of 2014–17. These top-paying firms held dominant positions in medical device markets [and] within the specialties that drive hospital spending on medical devices, these firms were even more dominant, accounting for 20 % of cardiovascular devices, 19% of neurology devices, 34% of orthopedics devices, and 13% of surgery devices.”
Current data do not allow health economists, for example, to see whether doctor payment programs present a hurdle to companies seeking to enter markets, reducing competition that might drive down product costs, the experts reported. They also found this:
“The market dominance of the top-paying firms [in payment programs] may reflect fundamental realities of the industry, such as a genuine need for collaboration between physicians and industry or scale economies in device development, production, and distribution. It may also reflect a pattern in which device market concentration is reinforced by payments to physicians. Future research that distinguishes these potential underlying mechanisms would have important implications for health and antitrust policy.”
Alas, the researchers reported that, unlike with drugs, it is difficult to track company payments forward to see results — whether doctors who get sums from makers then choose their devices. But the data show that doctors who get device maker payments bill higher to Medicare than those who do not.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Patients need to know that doctors are keeping their care first and foremost in mind and that they are not inappropriately nudged or swayed or even corrupted by outside cash. They also must know that doctors order drugs and devices for them that are safe, affordable, and optimal for their needs.
The opioid abuse and drug overdose crisis — which data increasingly indicate is worsening far more than estimated before — has provided textbook examples of how Big Pharma pushed to unacceptable levels the advertising, sales, promotion, and purported professional education on behalf of their products with payments of various kinds.
The crisis was fueled by and its history is replete with awful examples of physician speaker programs. Insys executives, several of whom were convicted on federal charges, became notorious for prodding sales personnel to use sexually suggestive pitches to doctors, including in speaker programs. Purdue Pharmaceuticals pushed the programs hard to pitch pain-management strategies to doctors focused on the company’s problematic product OxyContin.
The inspector general’s office of the giant federal Health and Human Services (HHS) agency has warned drug- and medical device-makers that pandemic-paused marketing shams should not resume because their in-person gab fests in the last three years — programs at posh resorts with expensive meals and flowing booze amid “continuing education” talks — look sketchy at best to federal watchdogs and prosecutors.
We have much work to do to get unacceptable, compromising cash paid to doctors in various ways out of the prescription drug and medical device businesses. The new research is helpful, and the experts are correct that much more is needed. They offered an excellent suggestion how, by the way: Federal regulators not only should push makers to include unique, identifying tags and numbers on medical devices, the so-called UDIS. This information also should go into patients’ medical records, allowing regulators to better track unsafe and problematic products and for all to see more information on which devices doctors choose and potentially to ask why.