PROSTATE CANCER Use of Open Payments Program Database to Study Financial Conflicts of Interest in Urology
By: Anna-Lisa V. Nguyen, BHSc, Schulich School of Medicine and Dentistry, London, Ontario, Canada; David-Dan Nguyen, MDCM, MPH, University of Toronto, Ontario, Canada; Christopher J. D. Wallis, MD, PhD, University of Toronto, Ontario, Canada, Mount Sinai Hospital, Toronto, Ontario, Canada, University Health Network, Toronto, Ontario, Canada | Posted on: 19 Sep 2023
Interactions between health care professionals and the pharmaceutical and medical device industries are essential to advancing medical knowledge and fostering innovation to ultimately improve patient care. This is also true in urology. Urologists often engage in research and clinical trials sponsored by pharmaceutical and medical device companies, which help generate important data, develop new therapies, and refine existing treatments.
However, financial relationships between physicians and industry stakeholders may also generate conflicts of interest. These may influence medical decision-making, prescription practices, and reporting of research. For example, recent research demonstrated a relationship between payments from benign prostatic hyperplasia surgery device manufacturers and positive published positions on that company’s device by key opinion leaders.1 To maintain the integrity of the profession and ensure patient trust, it is crucial to address and manage these conflicts of interest effectively.
The focus of this article is to explore industry payments to urologists, shedding light on the available evidence and discussing future research and initiatives needed in this space.
Open Payments Database
It has nearly been 10 years since the Centers for Medicare & Medicaid Services released the Open Payment Program (OPP) database which contains payments made to physicians by manufacturers of federally covered devices, drugs, or medical supplies. Physicians’ ownership or investment interests are also captured. The purpose of the program is to enhance transparency in the health care system. To date, it is arguably the most significant initiative of its kind and contains more than 78.8 million public records that total $63.2 billion US (USD) in transactions.2 In the last decade, much of the research on industry payments to urologists has relied on OPP.
Industry Payments to Urologists: What do We Know?
Research using OPP reports from 2014 found that $32.4 million USD was being paid to over 8,000 urologists annually. As a whole, urologists were ranked eighth highest in terms of median total value of payments per capita out of all specialties.3 Between 2014 and 2018, 75% of urologists received at least 1 reported industry payment. While most received less than $1,000 USD annually, in aggregate, this represented over $168 million over these 5 years.4
Future Research: Differential Allocation of Industry Payments
While general characterizations of industry payments have been the focus of the last decade, there is growing interest in characterizing subgroups of physicians with important influence on practice.4-7 OPP data have been used to describe industry payments in urology using variables such as subspecialty, academic involvement, editorial board involvement, and guideline authorship.4,6,8 While these prominent urologists’ relationships can be beneficial in advancing therapies through industry collaboration, the patients’ best interests and trust must be at the forefront.
Moreover, future research can seek to further characterize urologists receiving industry payments and comparing them to the average urologist. Such analyses may elucidate avenues for further targeted policy development or investigation of the influence of industry on urological practice. We recently presented data evaluating high-payment urologists (eg, received more than $50,000 USD in general payments in a single year). We found that the overwhelming majority of recipients were male, the most highly represented subspecialty was urologic oncology, and 60% held an academic appointment.5 These individuals represent 1% of all US urologists who received general personal payments from industry in 2021. Interestingly, the AUA census in 2022 allows us to further contextualize our work: while gender and subspecialty representation is relatively proportional, academic urologists are proportionally overrepresented among those receiving large industry payments.9 While this may not be surprising considering the academic roles of urologists practicing in university settings, it is important given the influential role these physicians have on the training of resident physicians, the published literature, and guidelines. Differences in distribution between AUA membership and urologists included in OPP data can help uncover additional patterns and inform future work in mitigating the potential negative outcomes of industry payments while maximizing the benefits.
Ultimately, the intended purpose of OPP is to enhance transparency of industry payments to providers. Research using OPP should strive to achieve this by providing informative and actionable analyses of the data. For example, OPP research can inform greater regulation of industry payments to urologists in positions of academic or clinical leadership. Many countries and professional organizations have implemented regulations and guidelines that require the disclosure of financial relationships between health care professionals and industry stakeholders. Transparent reporting allows patients, researchers, and regulatory bodies to assess potential conflicts of interest and make informed decisions based on complete information. The National Comprehensive Cancer Network has set forth disclosure policies to protect the integrity of guideline development. Such examples of policies include deeming those who receive more than $20,000 annually from a single external entity or $50,000 annually from all entities ineligible for service or appointment for involvement within guideline working groups.10
Professional organizations play a vital role in ensuring transparency and ethical conduct. They can provide guidelines for interactions with industry, offer educational programs on conflicts of interest, and facilitate disclosure processes. Additionally, fostering a culture of disclosure and promoting the reporting of financial relationships can help reduce the stigma associated with such collaborations. OPP research can provide evidence and targets for these organizations.
Collaboration between urologists and industry stakeholders is crucial for advancing medical knowledge, improving patient care, and promoting innovation. However, it is equally important to address the ethical concerns and potential conflicts of interest that may arise from these relationships. Transparency and disclosure play a pivotal role in maintaining the trust of patients and the wider health care community. By striking a balance between collaboration and transparency, urologists can uphold the highest ethical standards while driving advancements in urological care for the benefit of patients worldwide.
Initiatives such as the OPP database have significantly enhanced our ability to study potential financial conflicts of interest. While it has illuminated numerous aspects of conflict of interest in medicine, it should be viewed as a resource to inform bolder and more effective action to tackle industry-related conflicts of interest while maximizing the benefits of industry and urology partnerships.
Conflict of Interest Disclosures: Christopher J. D. Wallis: Consulting Fees: Janssen Oncology, Nanostics Inc, SESEN Bio, Precision Point Specialty LLC; Honoraria/Travel: AbbVie, Astra Zeneca, Bayer, EMD Serono, Haymarket Media, Healing and Cancer Foundation, Knight Therapeutics, Science & Medicine Canada, TerSera Canada, Tolmar Pharmaceuticals Canada; Research Funding: Knight Therapeutics, Tolmar Pharmaceuticals, Bayer. All other Authors report no conflicts of interest.
Funding Source: No funding.
- Singh A, Faris S, Agarwal P, et al. Association between industry payments and published position on use of devices for the treatment of lower urinary tract symptoms. Urology. 2022;159:87-92.
- Centers for Medicare and Medicaid Services. Open Payments Data Overview. 2023. Accessed June 28, 2023. https://www.cms.gov/openpayments/data
- Modi PK, Farber NJ, Zavaski ME, et al. Industry payments to urologists in 2014: an analysis of the open payments program. Urol Pract. 2017;4(4):342-348.
- Clennon EK, Lam M, Manley A, et al. Patterns of industry payments to urologists from 2014-2018. Urology. 2020;140:44-50.
- Nguyen D-D, Nguyen A-LV, Khondker A, et al. PD32-06 Industry relationships with urologists: characterizing the high-payment urologists. J Urol. 2023;209(Suppl 4):e909.
- Carlisle A, Bowers A, Wayant C, et al. Financial conflicts of interest among authors of urology clinical practice guidelines. Eur Urol. 2018;74(3):348-354.
- Perez TY, Chen MC, Chung PH, et al. Leaders in urologic education and their relationship to industry: an analysis of sunshine act open payments from 2014-2016. Urology. 2019;123:53-58.
- Nguyen D-D, Murad L, Nguyen AX-L, et al. Industry payments to American editorial board members for major urology journals. Eur Urol. 2023;10.1016/j.eururo.2023.04.017
- American Urological Association. Census Results. 2023. Accessed June 28, 2023. https://www.auanet.org/research-and-data/aua-census/census-results
- National Comprehensive Cancer Network. Disclosure Policies and Potential Conflicts of Interest. 2023. Accessed June 27, 2023. https://www.nccn.org/guidelines/guidelines-panels-and-disclosure/disclosure-policies-and-potential-conflicts-of-interest