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.