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More than $12 billion in payments were made from industry to physicians from 2013 to 2022, an analysis of payment data showed.

Over this time period, 85,087,744 payments with a total value of $12.13 billion were made by industry to 826,313 physicians, with 93.8% of these payments associated with one or more marketed medical products, reported Andrew Foy, MD, of the Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, and colleagues in a research letter.

"There is somewhat of a consensus, but it's certainly not shared by everyone in medicine or even in academic medicine, that physician-industry relationships ... may represent a conflict of interest," Foy told MedPage Today. "And that could have sort of deleterious consequences on physician prescribing in general, practices that are recommended by professional guidelines, and so on and so forth."

The top three drugs related to industry payments in the U.S. during the study period were rivaroxaban (Xarelto), apixaban (Eliquis), and adalimumab (Humira), with $176.34 million, $102.62 million, and $100.17 million in associated payments, respectively. The top medical devices related to industry payments were the da Vinci Surgical System, Mako SmartRobotics, and CoreValve Evolut, with $307.52 million, $50.13 million, and $44.79 million in associated payments, respectively.

Top-paid specialties included orthopedic surgery, which received a total of $1.36 billion, neurology and psychiatry at $1.32 billion, and cardiology at $1.29 billion. Pediatric surgery and trauma surgery received the lowest sum of payments.

Within each specialty, payments to the median physician ranged from $0 to $2,339, while the mean amount paid to the top 0.1% of physicians ranged from $194,933 for hospitalists to $4,826,944 for orthopedic surgeons.

Foy and colleagues noted that financial conflicts of interest are pervasive in medicine, despite evidence that they influence prescribing practices and harm patient-doctor relationships. The Physician Payments Sunshine Act established , a national repository of industry payments to physicians run by the Centers for Medicare & Medicaid Services.

"The OpenPayments database was created in response to concerns about the undue influence of the pharmaceutical industry and medical device industry on the prescribing patterns of physicians, the idea being that transparency would act to counteract some of that influence," Robert Steinbrook, MD, health research group director at consumer advocacy group Public Citizen, told MedPage Today. "I think what we've seen is that payments have become public, but the undue influence remains."

Steinbrook noted that though many of the payments were likely small sums for food and beverages, and a small number of large payments remain concentrated at the top, "patients would be better off if physicians had an arm's length relationship with industry, made independent decisions about what to prescribe, and either took no or very little industry money."

Adriane Fugh-Berman, MD, director of PharmedOut, a project at Georgetown University Medical Center that educates medical professionals about industry marketing practices, told MedPage Today that physicians should avoid industry relationships in favor of evidence-based care.

"Physicians should not consider industry a partner: pharmaceutical companies and medical device manufacturers are beholden to their shareholders, while physicians have a fiduciary responsibility to their patients," Fugh-Berman wrote in an email. "Physicians believe they can extract money and information from industry without being influenced, but numerous studies prove them wrong." Even small food and beverage payments could have an effect, she noted.

Intuitive, which makes the da Vinci Surgical System, told MedPage Today in an email that "the methodology of this paper does not take into account that all payments reported by Intuitive under a single medical device in reality represent the device and up to 200 instruments, and the associated surgeon training, education, case observation, and proctoring that is important to support safe and effective use of the da Vinci system. The comparison between all of the above and a single- or limited-use device or drug is misleading."

Foy said that "it's not like the database itself has led to a significant change in these payments, and I think that probably reflects the fact that it's really not a unanimously shared opinion among the profession that this is necessarily a bad thing."

"At least in my field, for instance [cardiology], it's not a big deal. Sometimes you see speakers at major conferences that might have multiple PowerPoint slides of disclosures, and it's just sort of like, they put it on the screen, they leave it up for a few seconds, and it doesn't really raise an eyebrow, to be honest," he added.

For this analysis, the researchers used data from the OpenPayments database from 2013 to 2022. A total of 826,313 of 1,445,944 eligible physicians had received payments and were included in the study. Included payments were for consulting services, non-consulting services, food and beverages, travels and lodging, entertainment, education, gifts, grants, charitable contributions, and honoraria.

They linked the data to the National Plan and Provider Enumeration System (NPPES), and coded physician specialties through this system's taxonomy. They determined the total amount of payments from industry to physicians by specialty, using 39 specialties delineated by the NPPES.

Excluding the year 2013 when data were only available from August, the total value of payments was highest in 2019 ($1.60 billion) and lowest in 2020 ($863.93 million). The number of physicians receiving payments was highest in 2015 (468,164) and lowest in 2020 (359,509). The total value of payments changed from $1.34 billion (to 443,367 physicians) in 2014 to $1.28 billion (to 424,417 physicians) in 2022.

Foy and colleagues were limited by the lack of records on payments made to other healthcare professionals (these were recorded beginning in 2021), reliance on industry reporting, a lack of data on certain payments like free drug samples, and on different durations of time that products were marketed (only cumulative totals were analyzed).

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