Research shows that financial relationships with drug companies impacts decision-making in ways that benefit drug companies, including altering prescribing habits. (Photo credit: Unsplash)
U.S. medical specialists, from neurosurgeons to anesthesiologists and oncologists, received billions of dollars worth of individual payments not related to research from pharmaceutical and medical device industries in recent years, a series of new studies show.
The payments raise concerns among researchers and public health advocates about how industry influence may negatively impact patient care.
The American Medical Association’s “Sunshine Act data release: Talking points for physicians” suggests maintaining industry relationships, including company-funded medical education, does not necessarily mean that physicians’ judgment has been inappropriately influenced.
However, evidence shows these types of non-research, direct-to-pocket relationships impact medical decision-making in ways that benefit drug and device companies.
They have been shown to increase healthcare costs for consumers and lead to implicit bias, unconsciously influencing physicians’ behavior in favor of certain industry products and services that may not necessarily be good for patients’ health. They can alter prescribing habits, for instance, and also factor into decisions about which medical devices to use.
Drug and medical device manufacturers are required under the Physician Payments Sunshine Act to report payments, items of value, and investment interests worth $10 or more to healthcare providers. Some states, hospitals, and academic institutions have their own rules limiting certain industry gifts and payments, but there are no federal laws limiting what an individual provider may accept.
From 2020 to 2023 alone, the total value of pharmaceutical and medical device industry general (non-research) payments to physicians exceeded $8 billion in value, according to the Open Payments Database records categorized by stakeholder. The number of physicians receiving these payments also increased by 28% in that period.
‘We have a systemic problem.’
As these payments persist, experts continue to sound warning bells.
“The money is so tempting that, in some ways, I’m not surprised, and there’s no watchdog,” says Dr. Lisa Cosgrove of the University of Massachusetts-Boston, whose research focuses on ethical, medical, and legal issues in organized psychiatry due to academic-industry relationships. “We have a systemic problem.”
General payments can range from consulting and speaking fees to gifts, travel, and meals. They also include royalties and licensing fees from sales of drug and medical device products based on an individual’s intellectual property.
Pharmaceutical and medical device companies often make these payments to individual medical professionals as part of industry-sponsored promotional activities, advisory roles, or continuing medical education. This contrasts with funding from industry for medical research, which often goes to institutions.
Most medical specialists receive free samples, small gifts, and occasional meals. Still, even modest gifts—which represent the vast majority of general payments—can shape medical decision-making, Cosgrove says.
For example, a recent report published in the BMJ journal Heart shows doctors who received industry-sponsored meals with a median value per meal of $17 were more than twice as likely to prescribe a new heart failure drug to Medicare recipients. An increase in the number of free meals for doctors was also linked to more Medicare bills for this drug and higher costs, the study shows.
Industry ties undermine patient care and public trust, says Dr. Adriane Fugh-Berman, a Georgetown University professor and director of PharmedOut. The organization, a project of the Georgetown University Medical Center, educates healthcare professionals and students about pharmaceutical and medical device marketing practices.
“It’s a very bad system. Commercially-supplied information is always designed to advance commercial goals,” she says. “It’s not objective, and the best chance that physicians have of avoiding biased commercial information is avoiding contact with industry and industry-provided information. They shouldn’t take gifts of any kind, whether they are meals or money from these companies.”
Fugh-Berman’s research has shown that industry gifts of any size are associated with more expensive prescriptions and more branded prescriptions, as well as a greater number of drugs prescribed to a patient, increasing the risk of adverse effects.
Consider:
- Neurology: Nearly 8,000 neurosurgeons in the U.S. received roughly $479 million in general payments from pharmaceutical and surgical device companies between 2019 and 2023, including 45 payments exceeding $1 million each.
The most common payments were for food and beverages. The largest contributors to total payment value included payments for royalties and licensing, consulting fees, acquisitions, and travel perks, according to the study published earlier this month. - Medical oncology: About 19,500 U.S.-based medical oncologists received more than two million general payments totaling more than $600 million from 2017 to 2023. Hematology-oncology received the highest total payment amount, and industry-sponsored conferences drove high-value transactions. Stock payments featured prominently in hematology.
“The steadily rising total payments, particularly in hematology-oncology, underscore persistent financial ties between industry and oncology practices,” notes one set of researchers. “This reflects a potential for influence that, while not uniformly problematic, requires ongoing scrutiny to balance innovation with unbiased clinical decision-making.” - Anesthesiology: Three-quarters of all actively practicing anesthesiologists in the U.S. received nearly $300 million in non-research industry payments from 2014 to 2023. The top 1% of anesthesiologists accounted for about three-quarters of total payments, with pain medicine specialists receiving median payments eight times higher than general anesthesiologists.
Nearly half of all non-physician anesthesia providers also received $7.2 million from 2021 to 2023, with significant increases in the payment amounts and number of professionals receiving general payments each year.
“This study demonstrated large financial relationships between industry and anesthesia providers, with a disproportionate concentration of payments among a minority of providers,” the researcher says in a first-of-its-kind study to be published next month [March 2025] in the Journal of Clinical Anesthesia. - Orthopedic surgery: Of 600 orthopedic surgery fellowship program directors (FPDs), 99% received non-research industry payments totaling more than $340 million between 2015 and 2021, adjusted for inflation. Most were for royalties or licensing ($246.6 million, 72.4%) and consulting ($53.6 million, 15.7%). The highest annual industry payments were seen in spine and shoulder/elbow surgery, with nearly 40% of program directors receiving over $100,000 each.
Many of these specialists own patents and co-invented a device, then receive royalties and payments from the manufacturer of the device, says Dr. Jerry Avorn, professor of medicine at Harvard Medical School and author of Rethinking Medications: Truth, Power, and the Drugs You Take.
“If I was getting a knee replacement, I would want to know whether my orthopedic surgeon was making more money because the device was something he got royalty on, as opposed to … being the best for my knee,” he says. - Radiology: U.S. physicians in radiology received more than $100 million between 2017 and 2021 in royalties and ownership fees. Of roughly 3,000 neuroradiologists in another study, published in November last year, 48% received at least one payment from industry between 2016 and 2021, including research funds. Gifts were the most frequent payment type, while speaker fees made up 36% of the total value of payments. The industry payments were highly concentrated, the study shows: The top 5% highest-paid neuroradiologists received nearly half of all payments, accounting for 84% of the total value.
- Endocrine surgery: More than 400 members of the American Association of Endocrine Surgeons received nearly $5.9 million in general payments between 2014 and 2020, with a median payment of $701 over that period. Food and beverage, travel and lodging, and consulting fees were the most common categories.
- Multiple specialties: Physicians across five specialties (allergists/immunologists, dermatologists, gastroenterologists, otolaryngologists, and pulmonologists) received $22.6 million in 2023—nearly four times the amount paid in 2017—for dupilumab-related promotional events related to dupilumab, an eczema drug. Marketing-related speaker fees made up the largest category of payments.
While the average payment of $280 went down by about $100, the number of transactions and physicians who received payments went up, with the highest single payment at more than $34,000. Past studies have linked industry-funded meal payments to increased prescriptions of dupilumab.
“As the indications for dupilumab continue to grow, it is crucial for physicians to be aware of the magnitude of industry payments and the potential effects on physician prescription patterns and their recommendations to patients,” the researchers say.
The Open Payments database contains information about the financial relationships between drug and medical device companies and healthcare providers. Search for providers receiving payments, as well as companies that have made payments, and review and download data for up to five states at once. Watch a short video to learn more about how the program works, what’s in the data, and how to use the search tool.
Reference
Elsamadicy AA, Cross J, Reeves BC, et al. Characteristics of reported industry payments to neurosurgeons from 2019 to 2022: The impact of COVID-19. Journal of Clinical Neuroscience. 2025;134:111089. doi:10.1016/j.jocn.2025.111089
