Small Minority of Psychiatrists Account for Bulk of Non-Research-Related Industry Payments

Although a majority of psychiatrists received at least one non-research payment from the pharmaceutical and medical device industry between 2015 and 2021, the bulk of these payments went to a tiny fraction of psychiatrists, according to a study published today in Psychiatric Services.

“Of note, psychiatry’s industry payment problem is relatively narrow in scope compared with industry payment patterns in other specialties,” wrote John L. Havlik, M.D., M.B.A., of Stanford University, and colleagues. “Federal-level efforts to target inappropriate physician payments from industry may do well to focus on the psychiatrists who make $10,000 or more from industry each year—a group comprising fewer than a dozen psychiatrists per state—rather than spending valuable resources on less targeted interventions.”

The authors analyzed non-research industry payments—including travel fees, consulting fees, meals, and gifts—to 56,955 psychiatrists between 2015 and 2021 using the Centers for Medicare and Medicaid Services’ Open Payments Database (OPD). The OPD was created in 2010 under the Physician Payments Sunshine Act.

They found that during this study period, psychiatrists received 2,600,264 industry payments totaling $357,971,774. A total of 42,713 psychiatrists (75.0%) received at least one payment between 2015 and 2021. But the distribution was highly unequal: The top 10% of psychiatrists (N=4,271) received a median of $11,459.41, accounting for 93.6% of all industry payments, while the top 1% received a median of $362,631, accounting for 74.7% of all payments.

Havlik and colleagues also found:

• Psychiatrists who were among the top 1% in the amount of industry payments received were significantly more likely to be primarily licensed in Florida, Ohio, Oklahoma, or Texas than elsewhere in the nation.
• Food and beverage accounted for the largest number of payments made to psychiatrists (86.9%), although consulting (5.4% of payments) accounted for the largest dollar amount ($269,027,560), followed by food and beverage ($50,439,781).
• The median psychiatrist received substantially less compensation from industry than did other specialists. In 2019, the median cardiologist received $725 in industry compensation and the median dermatologist received $414, compared with $166.38 for the median psychiatrist.

“Further research is warranted to explore the prescribing behaviors of psychiatrists who receive larger payments compared with the prescribing behaviors of those who receive smaller payments, as well as patterns of prescription by these highly concentrated industry-susceptible psychiatrists,” the authors wrote.

For related information, see the Psychiatric News article “Integrity Is Built Into the Process of Developing DSM-5-TR.”

(Image: Getty Images/iStock/skynesher)

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Physician Prescribing Changed Following Restrictions on Pharmaceutical Detailing

Clinicians at several academic centers that implemented policies restricting sales visits by pharmaceutical representatives prescribed fewer marketed medications and more generic medications than they did in the years before the policies went into effect, according to a study published Tuesday in JAMA. While the changes were modest, they were significant across six of eight major drug classes, including sleep aid medications and antidepressants.

More than a decade ago, medical centers in the United States began instituting policies to limit visits by pharmaceutical representatives promoting medications (a practice also known as “detailing”).

For the study, Ian Larkin, Ph.D., of the University of California, Los Angeles, and colleagues compared changes in the prescribing behavior of physicians at 19 academic medical centers that implemented new detailing policies—before and after the policies went into effect—with changes in the prescribing behavior of a matched control group of physicians not subject to such policies. The researchers focused on eight drug classes: lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia (sleep aids), attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs. 

Analysis of 16,121,483 prescriptions written between January 2006 and June 2012 by 2,126 attending physicians at the 19 academic medical centers and by 24,593 matched control group physicians revealed that the implementation of academic medical center policies was associated with a mean decrease in market share (share of prescriptions for a given drug within a drug class) of detailed drugs of 1.67 percentage points (95% CI, −2.18 to −1.18 percentage points; p < .001) and an increase in the market share of nondetailed drugs by 0.84 percentage points (95% CI, 0.54 to 1.14 percentage points; p < .001). Detailing policies were associated with statistically significant changes in market share for six of the eight drug classes: lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensive drugs, sleep aids, attention-deficit/hyperactivity disorder drugs, and antidepressant drugs. 

The magnitude of changes in physician prescribing varied across the 19 academic centers. Of the 19 academic medical centers examined, results were statistically significant for nine academic medical centers for detailed drugs and for eight academic medical centers for nondetailed drugs—a factor the authors noted may have been driven by the fact that academic medical center detailing policies varied widely. Eight of the 11 centers with the more stringent policies saw significant changes in prescribing.

“The study by Larkin et al. suggests that the policies physicians and clinical organizations adopt may influence prescribing, which may reduce patients’ out-of-pocket costs. However, restricting interaction between physicians and the pharmaceutical industry without replacing the education about novel drugs that it offers also has possible risks,” Colette DeJong, B.A., and R. Adams Dudley, M.D., M.B.A., wrote in a related editorial. The pair describes the potential benefits of pharmaceutical detailing before proposing several strategies for addressing conflicts of interest (COIs) related to industry marketing, including the development of an alternative method of drug education. 

“It has never been more important for physicians to come together to consider these alternatives, generate evidence about their effectiveness, and move the health care system toward solutions that lower costs for patients and minimize COIs,” they concluded.

For related information, see the Psychiatric News article “What’s in a Label?”

(Image: iStock/smartstock)

Physicians’ Personal Information Tracked by Medical Communication Companies, Study Finds

Authors of a study published in the Journal of the American Medical Association have found that medical communication companies (MCCs)are doing more than offering online continuing medical education (CME) courses to physicians—the companies may be monitoring clinicians' website behavior.

Researchers from the Mailman School of Public Health at Columbia University investigated the financial relationship between MCCs and drug companies and whether MMCs accurately represent themselves to clinicians. More than 19,000 grants were evaluated to assess the financial giving practices of 15 major pharmaceutical and device companies from Fiscal 2010.

Data showed that of the $657 million in grant money awarded, 26 percent was allocated to MMCs, followed by academic medical institutions at 21 percent and disease-targeting advocacy organizations at 15 percent. The MCCs receiving the most funding offered online CME courses and acknowledged using cookies and Web beacons to track physicians’ online activity, in addition to sharing personal information with third parties, including “educational partners” and companies with which they have a working relations. Although MCCs did not elicit users' explicit consent, the companies did interpret “participating in a CME course and navigating the website as an implicit agreement to share information with third parties.”

Paul Appelbaum, M.D., a former APA president and the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University College of Physicians and Surgeons, said that "even 'free' CME courses come with a price." As chair of APA's Committee on Judicial Action, Appelbaum told Psychiatric News that information collected by MCCs may be shared with pharmaceutical companies for market research or targeted promotions, leading to physicians being visited by certain drug representatives. He urged all clinicians to evaluate the privacy policies of the companies before signing up for CME courses. "If physicians aren’t comfortable with the amount of information they will be revealing, they should decline to participate," Appelbaum concluded.

To read more about pharmaceutical marketing, see the Psychiatric News article "Industry Influence Can Be Mediated by Understanding Theory Behind It."

(Image: shutterstock.com/Mathias Rosenthal)

Time to Re-Engage With Pharma

APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. Please send your comments to pnupdate@psych.org.

Drug companies aren’t held in high esteem by the public these days. There are many reasons for the companies’ poor showing, including high drug prices, aggressive marketing practices and direct-to-consumer advertising, efforts to buy influence with physicians, and, perhaps most egregiously, the suppression of data on drugs’ dangerous side effects. Couple these issues with the fact that innovative drug development has slowed to a crawl, and it’s not easy to muster much defense of the pharmaceutical industry.

But let’s face it, they need us and we need them. We must recognize the important, beneficial role that drug companies have long played in all areas of medicine. While not minimizing problems, we simultaneously must remember how products have improved the quality of health care and quality of life in our society, and their funding has helped to advance research, public outreach, and training.

To read more, click here.