Concern over $290 million industry payments to rheumatologists in US

The issue of industry influence over rheumatologists has again been raised with a US report showing that payments to clinicians of more than A$290 million for food, drink and speaker fees were made over a six year period.

An analysis of pharmaceutical industry fees declared on the Open Payments database showed that most payments were small (median $20) and the majority of rheumatologists (59%) received industry payments of less than $6600 between 2014 and 2019.

However while the median amount of payments received was $3700, there was a small group of rheumatologists, representing about 5% of the speciality who received more than $132,000 in payments.

These ‘key opinion leader’  rheumatologists accounted for almost 80% of industry payments, the report showed.

Male rheumatologists received over twice as much in payments on  average compared with female rheumatologists ($4,900 vs $2,700).

The authors of the report, published in Arthritis and Rheumatology, said it was a concern that the value of industry payments was continuing to increasing over time by an average of $4,900 a year.

They noted that almost half of the payments were made by three pharmaceutical companies (Bristol Myers Squibb 20%, Abbvie 17% and Pfizer 12%), and almost all were associated with biologic DMARDs or targeted synthetic DMARDs.

About half the payments were associated with ten drugs, the most common being apremilast, adalimumab and tofacitinib.

The payments were most commonly for speakers’ fees (47%), followed by consulting fees (23%), food and beverage (13%), travel and lodging (12%) and honoraria (5%).

The authors said their analysis revealed two distinct patterns of industry payments, with a large number of rheumatologists receiving relatively small amounts, and a small number receiving large payments – including 44 rheumatologists who accepted more than a million dollars

“The impact of [small] payments cannot be discounted, as even small gifts may affect behaviour and are associated with prescribing patterns,” they wrote.

There was also a link between large payments to rheumatologists and likelihood of those practitioners being involved in clinical practice guidelines, they added.

However, while the findings showed that industry payments were concentrated on a small number of rheumatologists and products, “the degree to which payments have influenced physician behaviour lies outside the scope of this work,” they concluded.

An accompanying commentary said that while payments to rheumatologists may be focused on new ‘game changing’ drugs, this may be at the expense of older off-patent medications and non-drug treatments.

From the patient’s perspective the influence of industry payments was difficult to justify, and the trend should be for them to go down not up, concluded  Dr Aaron Mitchell of the Memorial Sloan Kettering Cancer Center.

“Through our professional societies and other non-profit sources, we physicians are fully capable of staying up-to-date on new treatments without relying on industry meals and sponsored events,” wrote

“We should reconsider our participation in a practice which – existing evidence suggests – adversely affects prescribing while contributing to higher health system and patient out-of-pocket costs.”

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