11 May Payments to Physicians For Educational Training Linked To Increased Brand-Name Statin Use

MedicalResearch.com Interview with:

Dr.  Yeh

Dr. James Song-Jeng Yeh, MD
Brigham and Women’s Hospital
Boston MA

MedicalResearch.com: What is the purpose for this study?

Dr. Yeh: A number of factors influence physicians’ prescribing behavior, including physician’s knowledge and understanding of the drugs.  Pharmaceutical detailing and financial incentives may affect such behavior.  My interest in evidence-based medicine and how medical knowledge is translated into practice lead me to think about how physicians’ financial relationships with the pharmaceutical industry may affect prescribing patterns.

In our study, we linked the Massachusetts physicians open payment database with the Medicare drug prescription claims database to determine if financial relationships with the industry are associated with increased brand-name statin drug prescribing.  The open payment database reports payments that physicians receive from pharmaceutical and medical device industries.  The open payment database when linked to the drug prescription claims database allowed us to answer this question.

We looked at year 2011, when two of the most commonly prescribed brand-name statin drugs (Lipitor and Crestor) were not yet available in generic formulation.

The outcome measured was what percentage of all statin prescription claims (both generic and brand-name) were brand-names.

MedicalResearch.com: What are the main findings? What is my your away?

Dr. Yeh: We found that for physicians who do NOT have any reported financial relationship the median brand-name statin prescribing rate was around 18%.  This rate increased by absolute 0.1% for every $1000 received.   When we examined whether certain types of payments were associated with increased brand-name prescribing, we found that payments for “educational training” had a positive association.  That is, physicians who received such payments increased their brand-name prescribing significantly.

The study suggests that industry payments to physicians may exert undue influence on drug prescribing pattern.

MedicalResearch.com: What are the limitations of the study? What future research do you hope to see?

Dr. Yeh: The study looks only at the association and such relationships do not make this causal in nature.  Also, the study period was from 2011 and prescribing patterns may have changed since then with the availability of generic atorvastatin and the implementation of the federal sunshine open payment database.

One of the motivations for implementing the open payment database was to make conflict of interest, things that potentially impact healthcare behavior in a negative way, transparent.  It would be interesting to know what, if any, physicians’ behavior have changed since the databases were implemented?  It also would be of curious to know what is the public’s perception of such database, how they might use this, and how this influences their perception of their doctors?

Lastly, it would be important to know what effects the open payment databases have on research, advancing medical knowledge, and patient care.  Are all payment categories nefarious?  Are payments for marketing purposes the same as money used for legitimate research?  How does one promote objective and collaborative research between academic and the industry to advance medical knowledge and patient care without undue negative influence.

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Last Updated on May 11, 2016 by Marie Benz MD FAAD