Medical device firms’ payments to doctors far outstripped those from pharma, study shows

WASHINGTON — The medical device industry gave doctors consulting fees, lunches, lodging, and other incentive payments worth $904 million between 2014 and 2017, per a new study — more than $80 million more than the pharmaceutical industry lavished on physicians over the same time period.

Experts told STAT that the findings, published Monday in Health Affairs, raise new questions about the industry’s influence on physician behavior — particularly since the medical device industry pulls in far less in revenue than the pharmaceutical industry.

Doctors must report any payments they receive from medical device makers, pharmaceutical companies, and other businesses in a government database called Open Payments that aims to help patients, researchers, and journalists understand the financial relationships that might be influencing a physician’s opinion. But until now, virtually all of the attention and scrutiny of the payments, as well as research into the links between the payments and physician behavior, has focused on pharma.

While a tight-knit relationship between medical device firms and physicians is often necessary for training and product development, the large scale of payments may inhibit the public’s trust between the patient and their provider, the researchers and other experts said.

If the relationship between the patient and physician is “contaminated by perverse financial incentives, then it does erode the public trust, which is a sacred value in our heritage, our great medical heritage,” said Marty Makary, professor of surgery and health policy at the Johns Hopkins School of Medicine, who was not involved in the research.

Medical device firm representatives often work side-by-side with physicians in the operating room, educating them on how to use their product and receiving feedback for developmental purposes. Helping a doctor learn how to use a pacemaker or insulin pump is very different from explaining the dosages of a new pill.

This intimate relationship has sparked the development of breakthrough medical products. But medical device representatives often use the increased face-time with physicians as an opportunity to pitch their products, according to the study and industry experts.

Both Alon Bergman, co-author of the study and postdoctoral researcher at the Leonard Davis Institute of Health Economics and the Wharton School, and Aaron Mitchell, an oncologist and health services researcher at Memorial Sloan Kettering Cancer Research Center, worried that the influence of a salesperson in the operating room creates blurred lines when doctors are deciding which product is best.

“I find that problematic,” said Mitchell, who was not involved in the research. “It becomes a lot harder to [decide which product is best] when that salesperson is also taking you out to $500 dinners and pays you tens of thousands of dollars in consulting fees over the last few years.”

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