Public Release: 

Recent survey provides updated national estimate of doctors' financial ties to industry

The Dartmouth Institute for Health Policy & Clinical Practice

Since 2013, gifts and payments to doctors by pharmaceutical and medical device companies have been publicly reported. In addition, some medical centers, physician employers, such as Kaiser Permanente, and states have banned or restricted detailing visits, physician payments or gifts. Some manufacturers have also changed their practices for certain gifts. In order to better understand the effects of these changes, a team of researchers from Harvard Medical School, The Dartmouth Institute for Health Policy and Clinical Practice and the American Board of Internal Medicine in Philadelphia conducted a national survey of internal medicine doctors.

The researchers randomly sampled 1,500 internists and internal medicine specialists, asking 10 yes-or-no questions about "drug, device, or other methodically related company" interactions in the last year: food inside or outside the workplace; free drug samples; pens, notepads, T-shirts; honoraria for speaking; payment for consulting services; payment for service on an advisory board; costs of personal expenses for attending meetings; free tickets to events; subsidized admission to meetings; or conferences for which Continuing Medical Education Credits (CME) were awarded.

About three-quarters (72%) of respondents reported any financial tie to industry. The most common benefits received were drug samples (55%) and food and beverage in (48%) or outside (30%) the workplace. Few doctors reported receiving small gifts (8%) or consulting (4%) or service on a specific advisory board (3%). In 2017 (the year surveyed), specialists reported more meals than internists both inside and outside work, as did male MDs than female MDs. The researchers note that these differences were similar to those found in a national physician survey in 2009 with similar questions and response rates. Compared to 2009, fewer internal medicine doctors reported receiving all types of financial payments, with the greatest reductions related to food/beverage or tickets to sporting or cultural events (75% vs 42%) and speakers bureaus/consulting/advisory boards (18% vs 2%). Among cardiologists, the only significant differences were for drug samples (82% vs 60%) and speakers bureaus/consulting advisory boards (33% vs 8%).

"What the survey revealed is that while financial industry ties have fallen some over the past decade, a majority of doctors still reported them," says Dartmouth Institute Professor Lisa Schwartz, MD, MS, a member of the research team. "This is particularly concerning when you consider that free samples, which are among the most common financial tie reported, have been linked to the prescribing of high-cost brand-name drugs over lower-cost generic alternatives."

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