Aaron P. Mitchell, MD, MPH, discusses his research on the association of pharmaceutical industry payments to oncologists and their increased use of nonrecommended and/or low-value treatment methods. The study was presented at the 2023 ASCO Annual Meeting in Chicago, IL.

Transcript:

Aaron P. Mitchell, MD, MPH: My name is Aaron Mitchell. I'm a medical oncologist at Memorial Sloan Kettering Cancer Center.

Can you give some background about your study and what prompted you to undertake it?

Dr Mitchell: We previously did a systematic review of all studies asking the question of whether receipt of money from the pharmaceutical industry can sway physicians' prescribing patterns. We found 36 studies that asked this question. All of them, 36 of 36, found that the answer was yes. Physicians do change their prescribing after receiving industry payments. However, all of these studies looked at what I would call equivalent, or therapeutically substitutable forms of care. One might look at these studies and say, well, patients are getting appropriate care. Is this really a problem? The next question in my mind, motivating our current study, was to then ask okay, is there still in association with forms of care that could be characterized as nonrecommended, or low value, or potentially harmful in some way?

Can you briefly describe how the study was conducted?

Dr Mitchell: We used two data sources for the study. The first is open payments, which is a data set resulting from a transparency initiative called the Sunshine Act that was passed as a part of Obamacare. And it makes public any payments from the pharmaceutical industry to doctors. We have that, the record of payments that doctors have received. And then we used Medicare claims data to identify cancer patients, identify what cancers they had, and evaluate what treatments they received. Then we're able to link these two data sets together. We've got our patients with cancer, who may or may not receive one of the forms of care that we've identified as being nonrecommended or low value. We can identify who their doctor was, and we can identify by looking in that doctor's open payments record, did that doctor recently receive money from the manufacturer of one of these low value or nonecommended forms of care?

What were the key findings of your study?

Dr Mitchell: We looked at four forms of nonrecommended or low value care. I'll use an example of the drug abraxane, as compared to an older drug paclitaxel, for patients with lung cancer or breast cancer, where we have head-to-head data saying that these drugs have the same outcome. But abraxane or nab-paclitaxel is much more expensive. We asked the question, when a doctor had recently received money from the manufacturer of abraxane, were they more likely to use this more expensive and not any better drug, compared to the cheaper alternative? And we find that the answer is yes. And we control for patient factors, and then we also run a statistical model that adjusts for the physicians' factors, including their prior behavior. So we can really see what is an increase from that same physician's prior prescribing behavior, when they've recently received an industry payment.

Looking ahead, what potential impact do you hope your findings will have on addressing physician industry financial relationships, and nonrecommended treatments?

Dr Mitchell: My long-term hope is that we will really start to question the need for this common practice. Right now, it's very common for physicians to receive gifts. This is sometimes in the form of free meals, sometimes it's in the form of payments such as consulting fees or speaking fees. It's very common, especially within oncology. And I think our study is now the first to raise what I would describe as some real quality of care concerns with this.

Is there anything else you would like to add?

Dr Mitchell: It’s important to keep in mind that while we are measuring the transfer of things of value, both cash and also in-kind gifts, from the drug industry to doctors, I don't think that this constitutes the drug industry bribing physicians. I don't think that any physician here is doing anything, or providing care to a patient that they believe to be substandard or nonrecommended. What I think this is a story of, is not money changing hands, but it's really about doctors' information sources.

I think a lot of these payments, a lot of them are meals, which commonly occur when doctors, community oncologists, are receiving a free meal and also information from the drug industry. And I just think that it's not so much the meal, but the information that they're receiving as part of that meal that may be a little bit biased towards using that drug, that might make the company's drugs seem more favorable or downplay the side effects. And so, I think it's really where doctors are getting their information from and we're seeing the effects of that, rather than are they doing anything because they received a meal specifically or because they received a speaking fee?

As a consequence of that, I really do think that there's a role for organizations like ASCO to be doing more to be the core information source for doctors, for each other, and for our colleagues in community practice, as a lot of us are. I would say that there's a role for an organization like ASCO to maybe replace the industry as a source of prescribing information for a lot of oncologists.