SerpApi.Org
More than a quarter of physician-industry interactions for research funding also involved the doctor receiving general payments from that same sponsor, an analysis of CMS data showed.
In an analysis of nearly 60,000 physician-industry interactions, those payments peaked around the time the research began, Alon Bergman, PhD, of the University of Pennsylvania, and colleagues reported in JAMA Network Open.
"The temporal pattern -- rising prevalence in the months before, peaking at research payment start, then declining afterward -- suggests that financial relationships with sponsors often develop before or alongside research collaborations rather than independently," Bergman wrote.
Those payments include consulting fees, speaker honoraria, meals, or travel expenses, Bergman said.
"By itself, this is not a nefarious activity," he told MedPage Today. "It's impossible to observe from this data which payments increased the intensity of the [industry-physician] relationship and led to grant formation, or whether grant formation by itself created a more intensive relationship which led to these payments."
"But that's not to say that I don't think there are cases where conflicts of interest actually arise," he added. "There is a large amount of literature to suggest that, for example, physicians are affected by payments in how they prescribe drugs."
One reason for concern is that "industry-sponsored studies are more likely to report sponsor-favorable findings, and investigators with financial ties are more likely to report positive outcomes," he said.
As benign as he believes most of these payments to physician investigators may be, Bergman suggested several layers of disclosure and transparency could reduce the possibility of undue influence by funding companies.
A starting point, he said, is to create a system requiring greater disclosure at the beginning of any industry-funded research project, "not just when it comes time to publish a study ... but also at the research's start, at the institutional review board stage ... and where conflict of interest and potential safeguards could be considered."
Overall, Bergman found that 26.7% of these payments occurred in the year before research payments started, and 29.9% occurred the year after. Monthly payment prevalence rose from 5.3% at 2 years before the research began, to a peak of 9.2% at research payment start, and declined to 7.4% by 2 years later.
The amounts were not large, with a median of $342 to $387 during an 8-year period. Payments appeared to be slightly lower among physicians receiving larger research amounts, "possibly reflecting stronger institutional oversight for high-visibility research," Bergman wrote.
Adriane Fugh-Berman, MD, of Georgetown University Medical Center and pharmaceutical industry watchdog group PharmedOut, said Bergman's study "raises the question of whether non-research payments are used to audition -- even groom -- researchers to have positive perceptions of a company, their representatives, and the products they produce."
It could also "introduce subconscious bias into what should be an objective assessment of a drug," she added.
Neil Wenger, MD, MPH, director emeritus of the UCLA Health Ethics Center, said Bergman appears to have "identified a concerning issue."
"Even small gifts have been associated with behavior change, so taking any amount from a for-profit firm before initiating a research project is concerning and should be avoided," Wenger told MedPage Today. However, he noted the practice seems to be relatively uncommon, although "further study should evaluate whether this factor is elicited by journals, considered in peer review, and reported in publications."
