Introduction
Financial interactions between physicians and pharmaceutical companies
could foster healthcare innovation and improve patient care though
research collaboration. However, these interaction introduce financial
conflicts of interest (COIs) among physicians[1-3], potentially
biasing physicians’ decision-making such as clinical practice[4-6],
guideline recommendations[7-10], health policy[11], and
integrity of scientific research[12,13]. Pharmaceutical companies
made more than $236.0 million per year to physicians and healthcare
organizations for consulting and speaking compensations in
Japan[14]. The majority of these payments were directly made to
individual physicians. Previous studies reported that the majority of
all physicians received these personal payments for speaking and
consulting services other than food and travel payments in
Japan[7,8,15-32], surpassing those in other developed countries such
as the United States[3,33-44], Australia[45,46], and
France[47].
Among several disease areas, there is increasing attention to
neurological disorders from pharmaceutical industry. The number and
prevalence of patients with dementia is critically increasing in Japan.
There were 4.62 million patients with dementia as of 2012[48], and
it is predicted that more than 20% of all people aged 65 years and
older will have dementia by 2030[49]. The healthcare spending
related to Alzheimer’s disease drug were US$1.0 billion (JPY 1,073
billion) in Japan in 2018[48]. The sales of antidementia drugs
including memantine (Memary from Daiichi Sankyo), donepezil (Aricept
from Eisai), and galantamine (Reminyl from Takeda Pharmaceutical) was
$437, $220, and $160 million in 2017, respectively. Previous research
found that there were substantial financial relationships between
dementia clinical guideline authors and the antidementia drug
manufacturers. However, the whole picture of the financial relationships
between pharmaceutical companies and all neurologists has never been
investigated. Using a publicly accessible transparency database, we
investigated the extents and trends of personal payments from
pharmaceutical companies to all neurologists in Japan.