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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.

Pharmaceutical companies and medical device makers must report their payments to doctors 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.

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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.

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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.”

The researchers found that the device industry lavished the most money its payments to surgical specialists. Surgical specialists received seven times more money from device firms than drug vendors. These doctors, the paper noted, are far more likely to implant or otherwise use medical devices in their work.

“The companies know where their bread is buttered,” Mitchell said.

Advamed, a trade association representing medical device makers, emphasized the important partnership between their manufacturers and doctors — helping to develop and refine medical devices and then to train their peers on how to use them.

“This kind of collaboration between medtech and providers is critical, as working directly with doctors who provide medical and scientific advice helps to ensure patients have the highest quality care borne out of real-world experience in the doctor’s office and operating room,” CEO Scott Whitaker said. “Still, as this study suggests, it’s important to ensure that this relationship is appropriate.”

The researchers relied on an algorithm to help label the Open Payments data, since many of the entries did not specify whether a physician had been paid by a drug or device maker. The study was limited to Open Payments data, and didn’t look at whether the payments had had any effect on prescribing or product use.

And that’s where Bergman said the field needs to go next. He suggested further research could examine how financial incentives from medical device firms impact physician behavior. He and his co-authors also said that increased data transparency, like requiring unique medical device identifiers in medical claims, is critical for future studies.

“Almost nobody talks about medical devices,” Bergman said.

Correction: A previous version of this story misstated which entities are responsible for filing reports through Open Payments. It is the companies, not doctors, who must disclose the payments. 

  • The most important difference is the device doctors get royalties on sales not just payments for talks etc. see for example https://pubmed.ncbi.nlm.nih.gov/29258356/
    Steffen JE, Fassler EA, Reardon KJ, Egilman DS. Grave fraudulence in medical device research: a narrative review of the PIN seeding study for the Pinnacle hip system. Account Res. 2018;25(1):37-66.

  • It’s unlikely the patient will ever be told the truth about the devices because the “chatter” between the sales rep, device manufacturer, healthcare entity and insurance is secret. I know because I have tried – and every one told me it is none of my business what was done to me and what was implanted in my body. Case closed. And apparently HIPAA allows this – payment, operations & treatment. Why didn’t I ask? I did and I was lied to. How many times does a patient have to ask? A patient has to check and double check and most likely will not get the truth. Why? Because if the patient is told the truth, they would not agree to the operation so everyone involved has to lie. The patient is left to deal with the “results” of the operation. Case closed and the trust is gone.

    • Sandra, this is a remarkable experience. Can you contact me via my email. I’m a journalist and would like to followup in more depth.

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