Trust and Transparency: Patient Perceptions of Physicians' Financial Relationships with Pharmaceutical Companies

Abstract

Financial ties between physicians and pharmaceutical companies are pervasive and controversial. However, little is known about how patients perceive such ties. This paper describes an experiment examining how a national sample of U.S. adults perceived a variety of financial relationships between physicians and drug companies. Each respondent read a single scenario about a hypothetical physician and his financial ties to the pharmaceutical industry; scenarios varied in terms of payment type of (e.g., payment for meals vs. consulting fees) and amount. Respondents then evaluated the physician on several dimensions (e.g., expertise, trustworthiness, knowledge of new treatments, moral character, focus on patients' interests). Findings revealed that perceptions of the physician were more strongly influenced by payment type than by payment amount. Specifically, respondents were quite critical of doctors who owned drug company stock or received industry payments for meals and lodging, but were more forgiving of physicians who received free drug samples (which were perceived as benefiting patients) or consulting fees (which were seen as signaling physician expertise). Interestingly, physicians who received no payments, while seen as honest, were also viewed by some respondents as inexperienced or uninformed about new treatments. Implications for public policy and future research are discussed.

Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data

“…After royalties, the second largest category of payments made to orthopaedic surgeons was for consulting fees. As opposed to industry payments for food, travel, or gifts, which are viewed negatively by patients [8,32,41], patients mostly support physicians serving as industry consultants [29]. However, concerns remain for conflicts of interest in this type of financial relationship, and further study of the larger influence of industry consultants is needed [24].…”

The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment

“…In contrast to other experimental work, competence ratings were not affected by viewing payment disclosure. 27 Interestingly, out of 240 participants, only 7.9% of those who searched for their own physicians found them. However, viewing their own physicians on the disclosure website was associated with a decrease in fidelity and honesty ratings as the amount of payments received by their physicians increased.…”

“…Patients tend to find gifts of large personal value, such as paid dinners and golf tournaments, less acceptable than those that could have a direct positive impact on patient care, like textbooks or free drug samples. [25][26][27] The American Medical Association (AMA), healthcare systems, and at least five states plus the District of Columbia have created guidelines as to what they deem acceptable payment amounts for physicians. The AMA Code of Medical Ethics states that gifts Bin the general range of $100 are permissible,^but the empirical basis for this guideline is lacking.…”

“…30,31 Our primary objective in this study was to evaluate differences in levels of trust in individual physicians, the medical profession, and industry after viewing, or not viewing, online public disclosures of varying industry payments to physicians across four study arms. Unlike previous studies that relied on hypothetical scenarios, 27 we used a live public disclosure website, allowing participants to view payments to physicians in the context of thousands of other physicians and teaching hospitals. Trust was measured using four dimensions: 1) fidelity, pursuing a patient's best interests; 2) competence, avoiding mistakes and producing the best results; 3) honesty, telling the truth; and 4) global trust, a holistic aspect.…”

Caring for Patients or Organs: New Therapies Raise New Dilemmas in the Emergency Department

“…Viewed from the perspective of loved ones gathering in the ED waiting room or the public becoming aware of the existence of both EPR and uDCDD protocols, the situation seems similarly ripe for conflict of interest on the part of the clinician. Depending on how well one understands health care institutions or demands of research, one may find it quite possible that institutional pressures-for example, financial pressures, pressures to be viewed as "a player" in the organ transplantation arena, or pressures to gather more data about EPR-may influence clinician decision making (Perry, Cox, and Cox 2014).…”