2023-10-26 09:24:15
Research in the US ensures that cancer patients whose oncologist receives industry funding from the pharmaceutical industry appear to be more likely to receive certain treatments that are not especially recommended and of low value, according to a study published in ‘The BMJ‘.
This finding raises potential concerns about the quality of care that cancer patients receive in the US.
The researchers of Memorial Sloan Kettering Cancer Center de Nueva Yorkled by Aaron Mitchellsuggest that the current state of the pharmaceutical industry’s personal payments to doctors should be reexamined.
Speaking to ABC Health, Mitchell points out that the work has studied several forms of treatment that are not recommended or are unnecessarily expensive due to cheaper alternatives. «Some patients sometimes receive these incorrect treatments, but we have found that more patients receive them when their doctor has received money from the industry».
The researcher explains that the most common form of payment is free meals. “Sometimes it’s a lunch delivered to the doctor’s office and other times meetings at very expensive restaurants. Other common forms are speaking fees (the company pays the doctor cash for giving a talk about the company’s drug), consulting fees, and free trips and hotels. “There are some other less common forms, but these make up about 90%.”
The work has identified claims data for Medicare of patients with a new cancer diagnosis during 2014-19 who were at risk of receiving one of four non-recommended (guideline-advised) or low-value (provide no incremental benefit and are more expensive) drugs.
The two medications not recommended were: denosumaba bone-modifying drug for castration-sensitive prostate cancer, and granulocyte colony stimulating factors (GCSF) to prevent neutropenic fever in patients receiving chemotherapy.
Companies are free to make as many payments as they want, and doctors are free to accept them
Aaron P. Mitchell
Memorial Sloan Kettering Cancer Center
The two low-value drugs were: nab-paclitaxel instead of paclitaxel for patients with breast or lung cancer, and using a brand-name cancer drug when generic or similar versions are available.
The results show that the proportion of patients who received non-recommended denosumab within six months of their diagnosis was 31.4% for those whose oncologist had not received payment and 49.5% for those whose doctor had. received.
The researchers used a database of financial relationships between companies and doctors (Open Payments) to identify the oncologist assigned to each patient, noting the payments they had received from the manufacturer of the four medications in the year prior to the patient’s diagnosis.
The problem is that these payments are not regulated in the US, he warns. «Companies have to report on the payments they make, and this is recorded in Open Payments. But companies are free to make as many payments as they want, and doctors are free to accept them. In theory, a law known as the Anti-Bribery Law Bans Bribes Paid to Doctors to Reward Them for Prescribing Medications. This has been applied in serious cases of abuse. However, it has never been applied to the types of routine, everyday payments such as those we study in this report, so these remain effectively unregulated.
And according to this researcher, The situation in Europe is not much better. “In fact, to my knowledge, it is even worse, as most European countries (with a few exceptions) do not have a robust public reporting system like the Open Payments database in the United States.”
The authors acknowledge that this is an observational study, so they can only conclude an association between industry payments and prescribing and cannot infer causality, and note that the misclassification in the claims data and their focus on a small group of patients and interventions may have influenced their results.
Code of Good Practices
Spain is the only country in Europe that, within a self-regulation system, publishes 100% of collaborations with organizations and healthcare professionals on an individual basis. The economic collaborations of pharmaceutical companies based in Spain that are adhered to the Farmaindustria Code of Good Practices and agents in the sector reached in 2022 the 667 million euros: 313 millions for health organizations and professionals to participate in research and development of new treatments; 218 to support continuing training activities –130 to health organizations responsible for scientific-professional meetings and congresses and 88 to aid to health professionals to facilitate their participation in this type of meetings. To the aforementioned areas of research and training, two other concepts are added: the provision of professional services, for a global value of 92 million euros, and donations, which can only go to health organizations and which amounted to 44 million in 2022
However, they say the influence of industry payments on physician behavior is well established, and this study suggests that this influence has the potential to negatively affect the care of individual patients.
In his opinion, the reason why these payments influence doctors is that they are often accompanied by information from the company. “The company brings free food to the hospital and then informs the doctor about its newest and best medications. However, we know that the information provided by the industry is biased and minimizes the risks of treatment. In summary, this practice should stop. “Physicians should obtain their prescribing information from unbiased sources.”
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