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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Wednesday, April 25, 2007
More than a quarter of doctors paid by industry, survey shows
Lunch in the doctor's office courtesy of pharmaceutical company reps and payments to physicians who speak at conferences aren't new, but the proportion of physicians reporting that they get money from industry and how that varies by specialty may be important for efforts to control these relationships, according to an article in tomorrow's New England Journal of Medicine.
Researchers at the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School conducted a national survey of 3,167 physicians and found that 94 percent had some kind of relationship with the pharmaceutical or medical device industries. The respondents reported receiving drug samples (78 percent), gifts of food (83 percent) and sports or cultural event tickets (7 percent). More than a third (35 percent) received reimbursement for continuing medical education or meeting expenses.
More than a quarter (28 percent) got paid for consulting, serving on an advisory board or speakers bureau, or enrolling patients in clinical trials. This surprised the authors more than the 94 percent of doctors with some sort of tie, which could have been as little as a mug or pen, Dr. David Blumenthal said.
"I figured that direct payments went pretty much to people who were academic or opinion leaders, but it seemed to be far more common," he said in an interview. "The fact that more than a quarter of physicians are actually getting direct monetary payments tells me this remains an important phenomenon in American medicine and that the rules and regulations put into effect have not eliminated it."
In 2002, the Pharmaceutical Research and Manufacturers of America, the industry's trade group, put in place voluntary guidelines limiting certain gifts. Leading physician groups have also adopted similar rules.
Pediatricians were less likely than internists to receive payments or reimbursements. Anesthesiologists didn't get samples, reimbursements or payments as often as family practitioners, internists or cardiologists.
Cardiologists were more than twice as likely to be paid by industry as family practitioners were, perhaps because they are recognized as the ones who set standards for prescribing widely used heart drugs, the authors suggested.
Where the physician practiced also made a difference, they found. Group practice doctors were six times as likely to get samples, three times as likely to receive gifts, and almost four times as likely to receive payments for professional services such as consulting than doctors in hospitals, clinics or staff-model HMOS. Male doctors and those with fewer Medicaid or uninsured patients also were more likely to receive payments.
"Specialties, organizations and practice leaders with an interest in reporting and managing physician-industry relationships may need to develop guidelines and recommendations that are specific to the context of each specialty and setting," the authors wrote.