It’s long been known that financial links to industry may influence a clinician’s behaviour, but a new study reveals a more nuanced relationship between the pattern of payments received and haematologists’ prescribing.
Clinicians who have long-term links with a pharma company and those who receive payments for ‘consulting’ rather than just ‘wine and dine’ educational meetings are mostly likely to be swayed in their prescribing, according to US research.
But surprisingly, the association between payments and prescribing did not appear to be modified by an institution’s Conflict of Interest policies, a study published in The Oncologist found.
Researchers at the Sloan-Kettering Cancer Center in New York used the Open Payments database to analyse the size, duration and type of drug company financial payments made to 2766 haematologists and oncologists.
Overall, almost 70% of clinicians received some kind of payment over a three year period, with the most common being financial support to attend education meetings (26-56% depending on cancer type). A smaller proportion (5-12%) received compensation payments for consultancy, speaker fees and travel.
For oncologists who received industry payments continually for three years there was a significant increase in their prescribing of the sponsor’s drugs for chronic myeloid leukaemia (RR 1.22compared to no payments for dasatinib, imatinib, nilotinib). There were also significant increases in prescribing of lung cancer drugs (Relative Risk 1.69; afatinib, erlotinibm) and drugs for renal cell cancer (RR 1.81; axitinib, everolimus, pazopanib, sorafenib and sunitinib )
However there was no significant increase in prescribing for clinicians who received intermittent industry payments for only one or two years. The strength of the payment-prescribing association did not vary by type of institution or their Conflict of Interest policies, but was stronger for doctors who accepted higher value payments of more than US$100 annually compared to those who did not.
The average industry payment was US$2825 for CML, $1104 for lung cancer and US$3657 from renal cell cancer drug marketers. Some key opinion leaders received up to US$167,000 a year in payments from industry.
The researchers said their study could be used to help develop more effective Conflict of Interest (COI) policies.
“This study begins to illustrate the complexity of the relationship between industry payments and oncologist prescribing, beyond simply demonstrating that an association exists. The increased understanding of these factors resulting from this study should help to inform the management of physician-industry relationships prospectively,” they wrote.
“It may support a greater emphasis in COI policies on long-term relationships between physicians and a single company, relative to shorter term or intermittent relationships,” they added.
The finding that prescribing increases were largely concentrated among physicians who received ‘compensation’ payments such as speaker and consultancy fees might suggest less focus was needed in Conflict of Interest policies on clinicians who accept a single meal, they suggested.
Recent transparency reports from Medicines Australia show that healthcare practitioners receive about A$20 million annually from pharma companies.