A new survey finds that, while the number of physicians who report having relationships with pharmaceutical manufacturers or other industrial companies has dropped in recent years, the vast majority of them still maintain such relationships. The study, conducted by the Mongan Institute for Health Policy (IHP) at Massachusetts General Hospital (MGH), appears in the Nov. 8 Archives of Internal Medicine and also documents changes in the frequency of particular types of relationships.
"While physician-industry relationships have decreased significantly since 2004, they are still found among more than three-quarters of those responding to our survey," says Eric G. Campbell, PhD, of the Mongan IHP, who led the study. "The persistence of industry's substantial financial interaction with U.S. physicians supports the need for a nationwide system to publicly report these relationships."
In 2004 members of the same research team published the first national survey of physician-industry relationships, in which 94 percent of respondents reported at least one type of drug industry relationship. Receiving prescription samples or food in the workplace were reported most frequently, and reimbursement for the costs of medical meetings or continuing education, as well as speaking and consulting fees, were also common.
Since that time, considerable attention by the media, government and academic institutions to conflict-of-interest concerns has led to new regulations and policy changes designed to improve disclosure of and, in some instances, prevent such relationships. To investigate whether these measures have changed the prevalence of physician-industry relationships, the investigators surveyed physicians in seven specialties – internal medicine, family practice, pediatrics, anesthesiology, cardiology, general surgery and psychiatry – from across the country. Almost 1,900 completed the survey, a response rate of 64 percent.
The overall rate of physician-industry relationships dropped from 94 percent to 84 percent. Receiving drug samples or gifts such as food and beverages was most frequently reported, with rates of 64 and 71 percent, respectively. The percentages receiving reimbursements or payment for services to companies were about half what they were in 2004. The number of meetings respondents reported having with pharmaceutical company representatives dropped from an average of three a month to two, a change the authors note could reflect greater pressures on physicians' time as well as institutional policy changes.
As in 2004, cardiologists were most likely to report industry relationships, while psychiatrists – a specialty not included in the earlier survey – were the least likely. Physicians in solo, two-person or group practices were more likely to receive drug samples, meeting reimbursements or gifts than those in hospitals and medical schools; but academically based physicians were most likely to receive payments for speaking, consulting or serving on advisory boards.
To examine the potential impact of industry relationships on health costs, the survey included a new question asking how often physicians had prescribed a brand name drug when an equivalent generic was also available. Overall, respondents with industry relationships were more likely to self-report prescribing the more expensive drugs. Overall, physician-industry relationships were reported more frequently in regions with higher health costs.
"Our finding of a significant association between physician-industry relationships and the use of more expensive drugs suggests that future investigations of factors underlying high-cost medicine should explore the possible driving role of these relationships," Campbell says. "While the reduced number of meetings with industry representatives and the decreased frequency of some relationships may signal the slow death of the traditional marketing model based on gifts to physicians, the influence of industry continues to be prevalent and powerful." Campbell is an associate professor of Medicine at Harvard Medical School.
Additional authors of the Archives of Internal Medicine report are Sowmya Rao, PhD, Catherine DesRoches, DrPh, Lisa Iezzoni, MD, Christine Vogeli, PhD, and Paola Miralles of the Mongan Institute for Health Policy at MGH; and Dragana Bolcic-Jankovic, University of Massachusetts. This study, the second in a series, was supported by a grant from the Institute on Medicine as a Profession.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $600 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.
Journal
Archives of Internal Medicine