Another Useless Report On Industry Payments To Physicians

The discussion of the effect of corporate payments to physicians has taken a new turn; no longer do we need ProPublica to raise concerns, physicians are now raising them. I wished before doing a "me-too" study they would have provided more insight 

The report is an abstract from the American Heart Association’s recent convention and scientific sessions and looks at payments from device manufacturers to physicians and their use of their devices. The products in question were two types of defibrillators, equipment that senses lethal cardiac arrthymias and shocks you. They made use of datasets that reported on which and how many of these defibrillators were implanted by a physician and cross linked those physicians with payments they received from the Dollars for Doctors dataset of ProPublica. They found that 

“Physicians receiving the highest aggregate payment from a given manufacturer were far more likely to implant devices from that manufacturer than another manufacturer.”

So there is a correlation between the two events. Association is too strong a word because even though we “know” better, it does have a causal ring to it. And once again, we have no evidence of which came first, the behavior or the payment.

Here is their data summary

Physicians receive “payments” from device manufacturers and drug companies in three broad categories. Some are royalties and licensing agreements for technologies developed by physicians and used by companies – they run into far larger payments and probably not the ones considers. Some are “free lunches,” used to get into the office and in front of a customer, a physician – but few physicians, especially interventionalists get $5,000 worth of lunches a year. And then there are payments to physicians to discuss a device or drug with colleagues in the setting of medical education. So while I do not know for sure, I would suspect that most of these payments are for talking to other physicians, advocating for a specific device.

Given their advocacy, is it surprising that they use one device more than any other? And if you look at the number of devices implanted, you can see that three of the companies have divided up the market fairly evenly, with the fourth manufacturer running a distant fourth. If physicians are both big users and a respected local or regional “authority,” is it surprising that a device manufacturer would ask them to “spread the word,” and drive their market share? But which came first, the payment or the use? The lens of ethics asks whether the payment influenced the behavior; the lens of marketing suggests that the behavior influenced the payment. Nothing in this presentation or more importantly, the more widely publicized Dollars for Doctors website, answers that question. 

Source: Association Between Industry Payments to Physicians and Device Selection: A Report From the NCDR ICD Registry AHA Scientific Sessions2018