Limitations
This study included several limitations. First, there would be
underestimated payments made by non-member companies of JPMA to the
otorhinolaryngologists. However, as the member companies accounted for
80.8% of total pharmaceutical sales in Japan in 2018,[1] such
underestimation of payments could be minimized by including data from
all member companies. Second, the pharmaceutical companies were not
required to disclose other categories of payments such as meals,
beverages, travel, and stock ownerships at an individual level,
according to the JPMA guidance.[3] This could have led to
underestimations of the extent and prevalence of overall financial
relationships between otorhinolaryngologists and industries. Third, this
study included otorhinolaryngologists as of November 2021, as the
JSO-HNS did not disclose the name list of otorhinolaryngologists for
previous years. Therefore, this study would have included
otorhinolaryngologists who were not certified during the study period.
Fourth, the payment magnitude and trend may not be applicable to other
countries.