Public disclosure of industry payments made to doctors had an unintended effect of decreased trust in the medical profession, according to authors of a recent study.1

“We were interested in doing a rigorous evaluation of the effect of transparency of industry payments on patients,” says Genevieve P. Kanter, PhD, the study’s lead author and an assistant professor in the department of medical ethics and health policy at University of Pennsylvania Perelman School of Medicine in Philadelphia.

The Physician Payments Sunshine Act was passed to increase transparency of doctors’ financial ties with industry. “We wanted to see the degree to which that actually happened,” says Kanter. “We were interested in how this would play out in a real-world policy setting.”

Declining Trust

Researchers surveyed 1,388 individuals before the public disclosure of industry payments, and again two years later, about trust in their own physicians and in the medical profession overall. “We didn’t know what to expect with the trust measures because theory suggested that trust could move in either direction,” says Kanter.

The Centers for Medicare & Medicaid Services Open Payments database was launched to increase public trust. But research suggests that when patients know that individual doctors receive industry payments, the patients trusted those specific doctors less. The researchers found that transparency negatively affected both patient trust in their own doctors and in the medical profession.

Trust declined by 2.7%. “It may not seem large, but in the context of the medical literature on trust, where it’s hard to find any factors that move the trust measure to any appreciable degree, it’s a big deal,” says Kanter.

The 2.7% decline is similar to the negative trust effects of patients knowing about managed care incentives. There, says Kanter, “is a perceived tradeoff between patient care and cost-cutting.”

Few Find Out Directly

Industry payments have been publicly disclosed for more than two years. Yet, only 3% of U.S. adults knew whether their physicians received an industry payment, found another study.2

“The one consistent finding in transparency programs, both inside and outside of medicine, is that individual members of the public rarely access this information directly,” says Kanter, the study’s lead author.

Some people do not know about Open Payments, or have not looked up their physicians. Others have heard about industry ties indirectly from news reports or other sources.

“Because people aren’t accessing the database, they are painting physicians with too broad a brush,” says Kanter.

Media coverage typically focuses on bad actors, or doctors who receive particularly high payments. This makes people skeptical of all physicians, including their own. “There are reputational effects for all physicians based on the industry interactions of some physicians,” Kanter concludes.

This suggests it is in the best interest of physicians without industry ties to let it be known. “This can be done simply — maybe via a website notice, a link to the Open Payments website, or a sign in the waiting room,” says Kanter.

REFERENCES

1. Kanter GP, Carpenter D, Lehmann LS, et al. US nationwide disclosure of industry payments and public trust in physicians. JAMA Netw Open 2019; 2:e191947.

2. Kanter GP, Carpenter D, Lehmann L, Mello MM. Effect of the public disclosure of industry payments information on patients: Results from a population-based natural experiment. BMJ Open 2019; 9:e024020.

SOURCE

• Genevieve P. Kanter, PhD, Assistant Professor, Division of General Internal Medicine/Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia. Phone: (215) 898-2703. Email: gpkanter@pennmedicine.upenn.edu.