There’s no such thing as a free lunch
Thursday, May 11, 2017
A new JAMA study found that physicians received $2.4 billion in industry-related payments in 2015. The authors also note that many in healthcare don't recognize a "subconscious bias" related to such interactions with products repped by industry sales associates, and that creates a great deal of tension between the industry's financial relationships and its primary mission.
This may be fairly obvious news for many, but it's just getting some attention because there is now an actual study to move the conversation forward. At its most basic element, this is a story of possible ethics issues, or one of trained behavior built on time spent interacting with specific technology.
What does this mean? Researchers in the survey examined 2015 open payments reports for 933,295 allopathic and osteopathic physicians in the U.S. across specialties.
Accordingly, of all U.S. primary care physicians, 48 percent received industry payments of some kind, and 61 percent of surgeons reported receiving payments. Surgeons' average per-physician "payment value" — as reported — was $6,879, compared to $2,227 for primary care physicians.
The question is, do these "industry payments" influence provider decision-making? Apparently so, JAMA researchers say. The study authors said "considerable data" points to the fact that financial conflicts of interest are affecting physicians' decisions.
As Healthcare Dive points out, a JAMA study in 2016 found that pharmaceutical industry-sponsored meals led to "an increased rate of prescribing the brand-name medication that was being promoted' by those buying the meals. The authors in that study point to an "association" rather than a "cause-and-effect relationship."
Where the rubber meets the road is that while these payments are not truly compensation for services, industry company representatives can create subconscious biases through a variety of means.
For example, a medical device sales representative may try to get his company's devices into training programs. That way, when a physician needs to perform a procedure, the physician may only wish to work with tools and devices with which he trained. This may be unconscious bias, but the outcome definitely has an impact on care delivery.
This is where there may be ethical concerns. The technology, sold into programs, likely creates the subconscious desire on the part of the caregiver to perform care with those technologies, perhaps over the course of the caregiver's career. Trained on a product, you'll use a product. If nothing else, this approach creates sort of an unspoken brand loyalty program.
Will potential conflict of interest gain any attention in the coming weeks? JAMA and Healthcare Dive pontificate that this could be a possibility as we move into the age of value-based care.
Might there be more scrutiny as to where physicians find their money and the reasons why? Perhaps. Or perhaps this is already a well-known concept — a tradition of the way things are — and the JAMA study is just a footnote of that reality.
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