Deborah C Marshall1, Beverly Moy1, Madeleine E Jackson1, Tim K Mackey1, Jona A Hattangadi-Gluth2. 1. Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM). 2. Department of Radiation Medicine and Applied Sciences (DCM, JAHG) and Department of Anesthesiology (TKM), School of Medicine (DCM, MEJ), University of California, San Diego, La Jolla, CA; Massachusetts General Hospital Cancer Center, Boston, MA, (BM) jhattangadi@ucsd.edu.
Abstract
BACKGROUND: Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships introduce conflicts of interest. We examined the specialty variation and context of physician payments and ownership interest among oncologists. METHODS: We performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to US 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 (medical, radiation, surgical, and nononcology), and practice location linked with spending level (low, average, and high). Primary outcomes included likelihood, mean annual amount, and number of general payments. Secondary outcomes included likelihood of holding ownership interests and receipt of royalty/license payments. Estimates for each outcome were determined using multivariable models, including logistic regression for likelihood and linear regression with gamma distribution and log-link for value, adjusted for physician specialty, sex, sole proprietor status, and practice spending. All statistical tests were two-sided. RESULTS: In 2014, there were 883 438 physicians, including 22 712 oncologists, licensed to practice in the United States. Among oncology specialties, 52.4% to 63.0% of physicians received a general payment in 2014, totaling $76 million, $4 million, and $5 million to medical, radiation, and surgical oncology, respectively. The median annual per-physician payment to medical oncologists was $632 (IQR = 136-2500), compared with $124 (IQR = 39-323) in radiation oncology and $250 (IQR = 84-1369) in surgical oncology. After controlling for physician and practice characteristics, oncologists were 1.09 to 1.75 times as likely to receive a general payment compared with nononcologists (overall P < 001). There was a 67.6% difference (95% confidence interval [CI] = 63.6 to 71.5, P < .001) in the mean annual value of payments between medical oncology and nononcology specialties (vs -92.7%, 95%CI = -100.2 to -85.0, P < .001] for radiation oncology). Medical and radiation oncologists were more likely to hold ownership interest (adjusted OR = 3.72, 95% CI = 3.22 to 4.27, and 2.27, 95% CI = 1.65 to 3.03, respectively, P < .001 both comparisons). CONCLUSIONS: In 2014, industry-oncologist financial relationships were common, and their impact on oncology practice should be further explored.
BACKGROUND: Industry-physician collaboration is critical for anticancer therapeutic development, but financial relationships introduce conflicts of interest. We examined the specialty variation and context of physician payments and ownership interest among oncologists. METHODS: We performed a population-based multivariable analysis of 2014 Open Payments reports of industry payments to US 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 (medical, radiation, surgical, and nononcology), and practice location linked with spending level (low, average, and high). Primary outcomes included likelihood, mean annual amount, and number of general payments. Secondary outcomes included likelihood of holding ownership interests and receipt of royalty/license payments. Estimates for each outcome were determined using multivariable models, including logistic regression for likelihood and linear regression with gamma distribution and log-link for value, adjusted for physician specialty, sex, sole proprietor status, and practice spending. All statistical tests were two-sided. RESULTS: In 2014, there were 883 438 physicians, including 22 712 oncologists, licensed to practice in the United States. Among oncology specialties, 52.4% to 63.0% of physicians received a general payment in 2014, totaling $76 million, $4 million, and $5 million to medical, radiation, and surgical oncology, respectively. The median annual per-physician payment to medical oncologists was $632 (IQR = 136-2500), compared with $124 (IQR = 39-323) in radiation oncology and $250 (IQR = 84-1369) in surgical oncology. After controlling for physician and practice characteristics, oncologists were 1.09 to 1.75 times as likely to receive a general payment compared with nononcologists (overall P < 001). There was a 67.6% difference (95% confidence interval [CI] = 63.6 to 71.5, P < .001) in the mean annual value of payments between medical oncology and nononcology specialties (vs -92.7%, 95%CI = -100.2 to -85.0, P < .001] for radiation oncology). Medical and radiation oncologists were more likely to hold ownership interest (adjusted OR = 3.72, 95% CI = 3.22 to 4.27, and 2.27, 95% CI = 1.65 to 3.03, respectively, P < .001 both comparisons). CONCLUSIONS: In 2014, industry-oncologist financial relationships were common, and their impact on oncology practice should be further explored.
Authors: Giovanni M Bariani; Anezka C R de Celis Ferrari; Paulo M Hoff; Monika K Krzyzanowska; Rachel P Riechelmann Journal: J Clin Oncol Date: 2013-04-29 Impact factor: 44.544
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Authors: Kathryn R Tringale; Deborah Marshall; Tim K Mackey; Michael Connor; James D Murphy; Jona A Hattangadi-Gluth Journal: JAMA Date: 2017-05-02 Impact factor: 56.272