Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study
BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4189 (Published 18 August 2016) Cite this as: BMJ 2016;354:i4189All rapid responses
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Dear Dr. Ross and Dr. Fleischman,
Hope all is well. I recently came across your article published in the BMJ (August 18, 2016) on the "Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing". It was a very interesting article and I was wondering if you had the opportunity to conduct some additional analyses, specifically on the association between prescribing and the gifting of educational materials such as peer-reviewed journals, journal reprints, journal supplements, medical conference reports, and medical textbooks OR any payments (indirect or direct) for speaking at, attending, or preparing educational materials for educational events for doctors or other health care providers even if the conference does commercially promote drugs or devices. As you may be aware, Senator John Barrasso (R-WY) has introduced an amendment (S.2978 - Protect Continuing Physician Education and Patient Care Act) that would modify the Physician Payments Sunshine Act to exempt such gifts and payments from mandatory reporting. It would be great to know if you found evidence of any association between these potential exemptions and prescribing behavior.
Please let me know if you need any further clarification and many thanks for this excellent study.
All the best,
Reshma
Competing interests: No competing interests
Sir,
What a wonderful discovery !
Big Pharma has a million of studies explaining why they waste billion of pounds/euros/dollars with the aim of corrupting medical doctors. This philanthropic attitude is strengthened by this paper. Thanks to the authors.
But what goes well without saying, goes even better when you say it.
Best regards
Competing interests: No competing interests
Re: Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study
Author's reply:
Prompted by recently proposed amendment S.2978 [1] intending to exempt from mandatory reporting through the Open Payments program payments from pharmaceutical manufacturers to physicians related to physician education, Ramachandran asks whether we had conducted analyses examining the association between prescribing and payments related to educational materials.
In response, we performed a subgroup analysis focused on payments for continuing medical education (CME) speaker fees and for educational materials, including journal articles and textbooks, using the same methods described in the manuscript. In brief, we found that payments for CME speaker fees and educational materials associated with prescribing for both medication types. For oral anticoagulants, one additional CME/educational material payment per 1000 person years was associated with a 2.0% increase in regional market share, compared with 0.33% for all other payment types, translating to 598 (95% confidence interval 258 to 939) and 98 (79 to 1116) additional days filled of the marketed drug for one additional payment in a region, respectively (Table; P values <0.001 for associations, and P=0.046 for difference between payment subgroups). For non-insulin diabetes drugs, the corresponding associations were 1.47% and 0.12% increases, translating to 1353 (942 to 1765) and 109 (91 to 127) additional days filled of the marketed drug for one additional payment in a region, respectively (P values <0.001).
Our findings demonstrate that payments made by pharmaceutical manufacturers to physicians in 2013 and 2014 for CME speaker fees and educational materials were associated with greater regional prescribing of marketed drugs among Medicare Part D beneficiaries and that the payment-prescribing associations of these payments was predominantly larger than the associations observed for all other payments types.
1. Barrasso J. S.2978 - 114th Congress (2015-2016): Protect Continuing Physician Education and Patient Care Act. Available from: https://www.congress.gov/bill/114th-congress/senate-bill/2978 (accessed 12 Sept 2016 .
Competing interests: WF serves as a volunteer researcher at the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Open Payments program. SA worked at CMS at the time of writing. JSR receives support through Yale University from CMS to develop and maintain performance measures that are used for public reporting, from Medtronic and Johnson and Johnson to develop methods for the sharing of clinical trial data, from the Blue Cross Blue Shield Association to better understand the generation of medical technology evidence, and from the Food and Drug Administration to develop methods for post-market surveillance of medical devices.