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Doctors Paid for Use of a Manufacturer’s Brand of Implantable Cardioverter-Defibrillator (ICD)

Another study of how Medical device manufacturers manage to pay doctors to prescribe their product, in this case, brands of ICDs. A JAMA study documented that “physicians were most likely to use the ICD brand from the manufacturer who gave them the most money.”

(But it should be noted that there was no association between the amount physicians received and postprocedural complications and/or death.)

Study of Payments to Doctors

In this study patients received a first-time implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) from any of the 4 major manufacturers.

A normal chest X-ray after placement of an ICD

A normal chest X-ray after placement of an ICD

Data came from the National Cardiovascular Data ICD Registry linked with the Open Payments Program’s payment data.

Over a 3-year period (2016-2018), 145,900 patients received these devices. They were implanted by 4,435 physicians at 1,763 facilities. 94% of these physicians received payments from these device manufacturers.

Between 38.5% and 54.7% of patients received devices from the manufacturers who had provided the physicians with the largest payments.

For example, doctors who received the highest payments from “manufacturer A” were about 6-fold more likely to use its product versus an ICD from a  company that didn’t pay them. This is according to Jeptha P. Curtis, MD, and colleagues at Yale School of Medicine in New haven, CT.

“Manufacturer D” did even better at rewarding doctors who used its ICDs. Those receiving the highest payments were 17-fold more likely to use its devices.

Is “Buying Off” Physicians Unethical and/or Illegal?

To this question Dr. Curtis replied:

“Instead I think it represents a softer type of influence. If I have a choice of devices from different manufacturers, and I have financial entanglements with one of them, it stands to reason that I will be more likely, consciously or not, to select that manufacturer, particularly if I do not think there is a difference in device performance.”

Current laws, such as the Anti-Kickback Statute and The Stark Law can be circumvented by saying the payments are for such things as speakers’ fees or travel costs. The Curtis study didn’t examine differences in types of payments such as consulting fees versus food and beverage payments (a definite limitation).

Editor’s Comments
Editor's Comments about Cecelia's A-Fib storyPayments to doctors by device manufacturers (and pharmaceutical companies), however they are justified, undermine the reputation and trust we ought to have in our doctors.
As consumers, we must do all we can to make sure that laws are written or revised to address these payments.

To quote Dr. Curtis, “Patients need to know that decisions regarding their care have been made on the basis of fact and science, not on how much money their physician received from a device company.”

Resources for this article

• Annapureddy, A, et al. Association between industry payments to physicians and device selection in ICD implantation. JAMA, 2020; 324(17):1755-1764. https://jamanetwork.com/journals/jama/article-abstract/2772494 doi:10.1001/jama.2020.17436

• Hlavinka, Elizabeth. Sunshine Act Brings Some Transparency but Little Change—Industry largess to physicians unaffected; strong link between payments and choice of ICD. Medpage Today, November 3, 2020.

• The National Cardiovascular Data Registry (NCDR®): The American College of Cardiology’s (ACC) suite of cardiovascular data registries helping hospitals and private practices measure and improve the quality of care they provide. https://cvquality.acc.org/NCDR-Home/about-ncdr

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