Discussion
This study investigated the financial relationships between the
pharmaceutical companies and all board-certified neurologists in Japan.
We found that 59.2% of all board-certified neurologists received
personal payments for lecturing, consulting and writing services from
the pharmaceutical companies in Japan between 2016 and 2020. The total
amounts of personal payments were more than $45.8 million over the five
years. Only the small number of neurologists received the substantial
amounts of personal payments from the pharmaceutical companies.
Furthermore, there were significant increasing trends in the payment
amounts and number of neurologists receiving personal payments over the
study period. To the best of our knowledge, this is the first analysis
examining the whole picture of financial relationships between the
pharmaceutical companies and neurologists in Japan.
Comparing with previous research, there were several important insights
from the study findings. First, Ahlawat et al. reported that 51% of all
neurologists received non-research payments including meal and travel
payments from the healthcare industry in the United States (US) in
2015[3]. The median annual payments per neurologist was $81 and
only 14.5% of neurologists received more than $500 in the US. Compared
to this previous study, our elucidated that both the proportion of
neurologists receiving payments and payment amounts per neurologists
were much higher in Japan than those in the US. Furthermore, the total
non-research payments made to all US neurologists in 2015 were $6.2
million including meal, travel, entertainment, consulting, honoraria,
royalties & licenses, and lecturing payments, while we found that at
least $8.1 million to $10.0 million per year were made for just the
three personal payment types including lecturing, consulting, and
writing fees. These findings indicate stronger and more widespread
financial ties between neurologists and pharmaceutical companies in
Japan.
However, the substantial and widespread financial relationships between
physicians and pharmaceutical companies was not only among neurologists
but also among other specialists in Japan. Previous studies in Japan
showed that the proportion of specialists receiving personal payments
were 45.3% for dermatologists[22], 52.8% for
gastroenterologists[23], 62.0% for pulmonologists[17], 64.7%
for hematologists[18], 65.4% for infectious disease
specialists[16], 70.7% for rheumatologists [21], and 70.7% for
urologists[20]. Additionally, the payment amounts to the
neurologists were also within the ranges reported in previous
studies[15,17,18,20-23,26].
Furthermore, we demonstrated that there were significant increasing
trends in personal payments to the neurologists between 2016 and 2019.
The significant decrease in payments to neurologists in 2020 would be
due to the COVID-19 pandemic and behavioral restrictions of physicians
and pharmaceutical company representatives to prevent SARS-CoV-2
infection, as highlighted in previous studies[54]. Considering that
these personal payments to physicians are associated with physicians’
clinical practice such as increased likelihood of prescribing brand-name
drugs rather than generic alternatives and increased healthcare
costs[4-6,55], the increasing trend in payments to neurologists is
an alarming finding. Future research should evaluate the associations
between payments to neurologists and their prescribing patterns in
Japan.
This study has several
limitations including possibilities of errors in payment data reported
by the companies and in the database. Additionally, because of
unavailability of several payment types such as meal, travel, royalty,
and gift payments in Japan, the financial relationships between the
neurologists and the pharmaceutical companies would be underestimated in
this study. Also, as this study only included payments from
JPMA-affiliated pharmaceutical companies, there would be unmeasured
financial relationship between the neurologists and non-JPMA affiliated
companies.
Despite these limitations, this study demonstrated that nearly 60% of
neurologists certified by the Japanese Society of Neurology received
personal payments related to lecturing, consulting, and writing from the
pharmaceutical companies between 2016 and 2020. Notably, these personal
payments concentrated on the small number of neurologists and
significantly increased before the COVID-19 pandemic period.