A decade ago, a controversial campaign in the US forced drug makers to disclose payments to doctors for speaking, consulting, travel, and research. It reflected concerns that medical practice and research may be influenced by financial ties, and it led to the creation of a federal database that lists all industry payments ̶ called OpenPayments.

Now, a group of researchers quantified the extent to which such efforts may have had on actual prescribing ̶ the results were positive.

A drop in prescriptions were found in three types of widely used medicines in Massachusetts, one of the first few states which required companies to report payments. The law officially went into effect in July 2009, a few years before the OpenPayments federal database.

The four-year project which looked at the law and prescribing patterns, proposed "a cause and effect relationship," explained S. Sriram, an associate professor of marketing at the Ross School of Business at the University of Michigan. The study is currently still undergoing peer review.

The team examined prescriptions written by Massachusetts doctors for brand-name and generic antipsychotics, antidepressants, and statins between 2008 and 2011. Sorting the trend was not straightforward as some brand-name drugs lost patent protection during that time and generic companies usually do not create financial relationships with doctors.

They also gathered prescription data for several border counties in New York and Connecticut as well to draw starker prescribing comparisons as those states did not have such a law.

Payment disclosures might have an effect on prescribing

Compared with doctors in New York, Massachusetts physicians prescribed 48% fewer brand-name statins, 46% fewer brand-name antidepressants, and 40% fewer antipsychotics. Compared with Connecticut doctors, they prescribed 59% fewer statins, 54% fewer antidepressants, and 45% fewer antipsychotics.

There was also a drop in generic prescribing for all three types of medicines of about 20% across the board, according to Sriram. The reason is still unclear; but he suggests that doctors may have been more cautious about prescribing medications in general.

“There’s ton of data showing payments increase the likelihood of prescribing,” stated Dr. Eric Campbell, a Harvard Medical School professor and research director at the Mongan Institute for Health Policy at Massachusetts General Hospital, who has also studied industry payments to doctors for more than a decade. "But, I’m not aware of any data that shows making payments public has changed what doctors do.”

There are some limitations as well as doctors practicing in other parts of the state may be self-employed or have different practice arrangements, which may affect prescribing decisions, Campbell explained. However, the study suggests that payment disclosures could make a difference.

Global call for transparency from the pharmaceutical industry

Other countries are trying to follow in suit, to write payment disclosures into the law.

In Canada, only 10 drug makers have disclosed any data and due to privacy laws, they did not release any information on payments to individuals and hospitals. One provincial health minister has voiced out this as a concern – suggesting mandatory reporting, and federal regulators are exploring steps that may be taken.

In the UK, the government is in the process of implementing something similar to OpenPayments as only 65% of physicians consented to share payment details, which showed a 25% increase in payments by drug makers to doctors and organisations compared to the year before. The data was collected by a pharmaceutical industry trade group called Disclosure UK.

“Increasingly doctors, nurses, and other healthcare professionals are doing the right thing in disclosing their collaborations with the industry. I am by no means complacent, however. We can and we should be achieving greater transparency,” said Mike Thompson, who heads the Association of British Pharmaceutical Industry. MIMS

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