July 14, 2016 | Patti Wieser
CTRI KL2 Awardee Jona Hattangadi-Gluth, MD
It may be “just a cup of coffee,” but meals and other remuneration from biomedical industries can influence the prescribing patterns and research reporting of physicians. New data shows that financial relationships between oncologists and biomedical industries are common, which could affect oncology practice and costs of cancer care.
“As physicians, we are committed to being objective and ethical, and putting our patients’ care first, but we may fail to recognize the influence of a meal, gift, stock, or honorarium from a pharmaceutical or device company,” said Jona Hattangadi-Gluth, MD, a radiation oncologist and assistant professor at UC San Diego School of Medicine. Hattangadi-Gluth, supported by UC San Diego Clinical and Translational Research Institute (CTRI) through a KL2 award, recently published a paper with her colleagues, “Distribution and Patterns of Industry-Related Payments to Oncologists in 2014,” in the Journal of the National Cancer Institute.
“Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships can introduce conflicts of interest,” said Hattangadi-Gluth.
The researchers performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to U.S. physicians matched to physician and practice data, including sex, specialty, practice location, and sole proprietor status. Payment data were aggregated per physician and compared by specialty to investigate the distribution, patterns, and specialty-specific context of these financial relationships. They found that industry-oncologist financial relationships were common, with 52 to 63 percent of oncologists receiving a general payment from industry in 2014. While the median annual per-physician payment to medical oncologists was $632, the average payment was much higher, skewed by a few outlier oncologists who received very large sums in the tens of thousands. Payments reflected meals, travel or lodging, honoraria, speakers’ fees, stock/investment options, and royalty or license fees. Manufacturers of top selling cancer therapeutics were among the top in highest value of payments to oncologists.
“This was the first study to explore oncologists’ financial ties to industry in an unbiased manner, matched to physician and practice-level data,” Hattangadi-Gluth said. “Previous studies relied on physician self-disclosure. This era of transparency means that anyone, including patients, can see payments and ownership interests from industry to physicians.” The Open Payments program is managed by the Centers for Medicare and Medicaid Services.
Studies on patient perception suggest that most cancer patients are not concerned about these financial ties, but they want them to be disclosed, Hattangadi-Gluth said. Often, patients view their physicians as having special expertise if the physicians are involved in therapeutic and device development.
The authors also found that high-spending practice locations were linked with pharmaceutical payments (i.e. areas with higher health expenditures are likely targeted by industry) and male physicians were more likely to accept payments than female physicians.
“As transparency of physician payments increases, it is important to understand the complexity of these relationships in oncology. While some of these relationships may represent problematic financial interests, many have positive consequences for cancer care,” Hattangadi-Gluth said. “The impact on oncology practice should be further explored.”
Hattangadi-Gluth received the KL2 award from CTRI to study the effects of radiation on brain function and how to minimize radiation damage to normal brain tissue and cognitive function in brain tumor patients. Additional research under the three-year grant focused on health policy issues, including industry-physician financial relationships and device regulation in oncology. Deborah Marshall, MD, the first-author of this study, was the recipient of a CTRI TL1 grant and spent a year working with Hattangadi-Gluth on these projects.
This month Hattangadi-Gluth begins a KL2 mini-sabbatical supported by the CTRI to develop and expand her knowledge base in neuro-oncologic care and brain tumor research in the UK; to hone her skills in imaging research; and to study health policy and foster new collaborations with the FDA. She will spend sabbatical time in London and Cambridge, UK; at University of California, San Francisco; and at the FDA offices in Maryland.