An analysis of CMS data found that more than a quarter of physician-industry interactions regarding research funding also involved the physician receiving general payments from the same sponsor.
In an analysis of nearly 60,000 interactions between physicians and industry, these payments peaked around the beginning of the research, reported Alon Bergman, PhD, of the University of Pennsylvania, and colleagues in JAMA network opened.
“The temporal pattern—increasing prevalence in the preceding months, peaking at the start of research payments, then declining thereafter—suggests that financial relationships with sponsors often develop before or alongside research collaborations, rather than independently,” Bergman wrote.
These payments include consulting fees, speaker fees, meals or travel expenses, Bergman said.
“In itself, this is not a nefarious activity,” he said MedPage today. “It is impossible to tell from this data which payments increased the intensity.” [industry-physician] relationship and led to the creation of benefits, or whether the creation of benefits alone created a more intense relationship that led to these payments.
“But that doesn’t mean that I don’t believe there are cases where there are actual conflicts of interest,” he added. “There is a large body of literature that suggests that physicians, for example, are affected by payment when prescribing medications.”
One concern is that “industry-sponsored trials are more likely to produce results that benefit the sponsors, and researchers with financial connections are more likely to report positive results,” he said.
As innocuous as he believes most of these payments to medical investigators may be, Bergman suggested that multiple levels of disclosure and transparency could reduce the possibility of undue influence by funding companies.
A starting point, he said, is to create a system that requires greater disclosure at the start of any industry-funded research project, “not only when it comes to publishing a study… but also at the beginning of the research, at the institutional review board stage… and where conflicts of interest and potential safeguards might be considered.”
Overall, Bergman found that 26.7% of these payments occurred in the year before research payments began and 29.9% occurred in the year after. The monthly payment prevalence increased from 5.3% two years before research began to a peak of 9.2% at the start of research payment and decreased to 7.4% two years later.
The amounts were not large, averaging between $342 and $387 over an eight-year period. Payments appeared to be slightly lower for physicians who received larger research awards, “which may reflect greater institutional oversight of high-profile research,” Bergman wrote.
Adriane Fugh-Berman, MD, of Georgetown University Medical Center and the pharmaceutical industry watchdog group PharmedOut, said Bergman’s study “raises the question of whether non-research-related payments are used to persuade – or even encourage – researchers to have positive perceptions of a company, its representatives, and the products they produce.”
It could also “introduce subconscious biases into the objective assessment of a drug,” she added.
Neil Wenger, MD, MPH, director emeritus of the UCLA Health Ethics Center, said Bergman appeared to have “identified a troubling problem.”
“Even small gifts have been linked to behavioral changes, so taking any amount of money from a for-profit company before starting a research project is concerning and should be avoided,” Wenger said MedPage today. However, he noted that this practice appears to be relatively rare, although “further research should evaluate whether this factor is identified by journals, considered in peer review, and reported in publications.”
https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/122300
