Financial payments from drug industry associated with physician prescribing

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Financial payments from drug industry associated with physician prescribing

Abstract: https://www.acpjournals.org/doi/10.7326/M20-5665

URL goes live when the embargo lifts

A systematic review of published research found that financial payments from the drug industry to U.S. physicians was associated with increased prescribing of the paying drug company's drug. The association was consistent across all studies and several studies presented evidence that the association was not correlation, but causation, meaning the industry gifts caused physicians to prescribe differently. The findings are published in Annals of Internal Medicine.

Financial payments from the drug industry to physicians is common and an issue of concern. Payments include both cash (typically for consulting services or invited lectures) and in-kind gifts, such as meals. From 2015 to 2017, 67% of all U.S. physicians received payments. This proportion exceeded 80% in some specialties (medical oncology, orthopedic surgery, urology, and others), and in many specialties the dollar value of personal payments has increased in recent years.

Researchers from Memorial Sloan Kettering Cancer Center reviewed 36 published studies comprising 101 analysis to evaluate whether receipt of payments from the drug industry is associated with physician prescribing practices. The researchers found that the literature was unanimous. Literally every study found an association between gifts and prescribing and the association was present among all specialties and drug types, including cancer drugs and opioids. According to the researchers, these results suggest that personal payments from industry reduce physicians' ability to make independent therapeutic decisions and that they may be harmful to patients. They recommend that the medical community change its historical opposition to reform and call for an end to such payments.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the corresponding author, Aaron P. Mitchell, MD, MPH, please contact Rebecca Williams at williamr@mskcc.org.

2. Ingesting a single battery mimics heart attack in adult male

Abstract: https://www.acpjournals.org/doi/10.7326/L20-1123

URL goes live when the embargo lifts

Ingestion of a single AA battery sparked a reaction that mimicked myocardial infarction on an electrocardiogram (ECG) in an adult male patient. This effect had previously only been seen in persons who swallowed several batteries. A case report is published in Annals of Internal Medicine.

Researchers from San Giovanni di Dio Hospital, Florence, Italy describe the case of a 26-year-old male prison inmate who visited their emergency department for abdominal discomfort after deliberately swallowing a single battery 2 hours earlier. The patient had no history of cardiovascular disease or cardiovascular risk factors, except cigarette smoking, but his ECG revealed ST-segment elevation consistent with acute ST-elevation myocardial infarction. He did not report any symptoms related to acute myocardial infarction, his serum troponin levels were within normal range, and his transthoracic ECG did not show alterations in cardiac wall motion or pericardial effusion. The clinicians removed the battery during endoscopy and all ECG abnormalities disappeared. Although the mechanism for this effect has not been established, the authors believe that a battery's entry into the acid contents of the stomach might facilitate an electric current that travels to the inferior portions of the heart, where it can be detected by an ECG.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The corresponding author, Marzia Giaccardi, MD, can be reached directly at marzia.giaccardi@uslcentro.toscana.it.

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