Lorenza Villegas doesn’t think her doctors should accept free lunches or other types of payments from drug companies.
But like most consumers, she hasn’t looked up whether her physicians are among the many who receive money.
“I’ve got other things on my mind,” said the East Garfield Park woman, 67, shortly after visiting Northwestern Memorial Hospital to make an appointment with her cardiologist.
Many patients feel the same way about checking whether their doctors have taken payments from drug and device companies.
It’s been four years since the federal government started releasing data online detailing the financial relationships between doctors and drug- and device-makers. Many government officials and researchers have hailed the website, known as the Open Payments database, at openpaymentsdata.cms.gov, as a triumph of transparency. But it’s unclear how much of a difference the data have made to patients or doctors.
What’s more, controversy remains over making the data public. Advocates say the information can help patients better understand their doctors’ potential motivations for prescribing certain drugs, while critics say it can be misleading and raise suspicions about doctors who are truly working in their patients’ best interests.
More than 28,000 Illinois doctors accepted $74.1 million from pharmaceutical and medical device companies in 2016, excluding payments for research, according to a Tribune analysis of recently released federal data. Those payments were for travel, meals, consulting, speaking fees and royalties, among other things.
Nationally, reported payments made to doctors have been slowly increasing. In Illinois, the numbers went down last year but are still higher than they were in 2014.
But just because the data are available doesn’t mean people are using it. In one yet-to-be published study, preliminary findings show only about 5 percent of patients surveyed last year knew whether their doctors had received payments.
It’s possible that even if people do know the data are publicly available online, “they don’t seem to care sufficiently to look it up,” said Genevieve Kanter, an assistant professor at the University of Pennsylvania who has studied the issue.
The database, created under the Affordable Care Act, was intended to help prevent payments from swaying doctors’ decisions. The federal government also encourages patients to use it to have conversations with their doctors about their financial ties to drug and device companies.
Whether those things are actually happening is a matter of debate.
The database has been a target of controversy since it first started. It’s unclear whether the database will remain if the Affordable Care Act is repealed and replaced but at least one senator, Chuck Grassley, R-Iowa, has said he doesn’t want to see the database weakened.
Grassley, who co-wrote the part of the health care law creating the database, said in a statement last year, “With taxpayers and patients paying billions of dollars for prescription drugs and medical devices, and prices exploding, disclosure of company payments to doctors makes more sense than ever.”
The American Medical Association, however, has long criticized the accuracy of the data.
Also, arguments continue over whether such payments are even a problem.
“Some payments are part of legitimate research relationships, and some are made for promotional purposes,” said Dr. Aaron Kesselheim, an associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston who studies physician financial relationships and conflict-of-interest issues.
In Illinois, the largest chunk of money received by doctors from industry — about 28 percent of payments excluding research, or $21.4 million — were for services such as serving as a speaker or faculty at a noncontinuing education event. Another 18 percent, $13.4 million, went toward consulting fees. Nearly 13 percent of the payments, about $9.5 million, were for food and drink, according to a federal analysis.
Some find those numbers troubling. A number of studies over the years have shown that certain financial relationships can drive doctors to favor particular products when choosing medications for patients.
“Drug reps do not see physicians unless they are affecting their prescribing, and pharmaceutical companies do not pay physicians unless they are affecting their prescribing,” said Adriane Fugh-Berman, director of PharmedOut at Georgetown University Medical Center, a research and education project examining industry’s effects on prescribing behavior.
Drug companies and many physicians, however, contend the financial relationships are about educating doctors.
Morry Smulevitz, a spokesman for North Chicago-based AbbVie, in a statement defended the payments the company makes to doctors: “Our interactions with health care professionals throughout the research and development process and in medical education bring value to patient care and are guided by openness and transparency.”
AbbVie last year paid more than 2,000 doctors in Illinois $1.6 million, the most of any Illinois company.
Nationally, AbbVie made about 285,000 payments totaling nearly $35 million to hospitals and doctors last year.
Many doctors also say the payments can help drive innovation and learning.
Topping the list of Illinois doctors receiving general payments last year was Dr. Anthony Romeo, head of the section for shoulder and elbow surgery at Rush University Medical Center and a team physician for the White Sox.
Romeo received $1.75 million in general payments. But the vast majority of that money was from royalties and licensing. He’s been designing and developing implants related to the care and treatment of shoulder and elbow conditions for more than 20 years and is prominent in his field. Most of the payments last year were from medical device company Arthrex.
“The fact of the matter is the work I do and many people do in designing new tools and products is the way we innovate in health care so we can treat our patients better,” Romeo said. The physician said he doesn’t get compensated when he uses the devices on his own patients or when Rush uses them on patients.
Romeo doesn’t believe the database has made a difference since it was unveiled four years ago.
“I think that a few people that abuse the system led to essentially government oversight that really I don’t believe has changed anything with regard to this whole process,” Romeo said.
Kesselheim, at Harvard, said he believes the database has made a difference by increasing transparency and helping researchers investigate relationships between doctors and industry. Ideally, he said, the data could also spark conversations between patients and doctors about care.
But little research exists on how many consumers actually use it.
Kanter, the assistant professor at the University of Pennsylvania, published a paper this summer in the Journal of General Internal Medicine showing that before the data were first released in 2014, only 5 percent of patients surveyed knew whether their doctors had accepted payments.
Kanter and her co-authors have since followed up on that study, again surveying patients last year. Preliminary results show the percentage of patients who knew last year whether their doctors had accepted money remained at 5 percent.
It’s possible that even when consumers know they can get the data, they don’t look it up because they don’t care or because they care about other factors more when choosing a doctor, Kanter said. Convenience, a patient’s relationship with a doctor and insurance coverage may factor more heavily in a patient’s decision-making than whether a doctor has accepted industry payments.
Some patients may even like that doctors receive payments from drug or device companies. A 2014 study published in Journal of Law, Medicine and Ethics found that doctors who received no payments were often viewed by patients as virtuous but also inexperienced or professionally isolated.
It’s also possible that patients don’t look up data about their doctors because they don’t know what to do with the information, Kanter said.
Should they talk to their doctors? Switch physicians? Ignore it?
“They may be confused about how they should interpret this information or how they should understand this issue,” Kanter said. “Even among researchers, there is debate about what it really means in terms of physician behavior.”
PharmedOut’s Fugh-Berman believes that patients with doctors who accept industry payments should change physicians.
“Any doctor who’s seeing drug reps or being paid by any companies is going to have less accurate information about drugs in general than physicians who don’t,” she said. “Drug reps are trained to deliver messages in a way that advantages their products.”
Others, however, suggest a less black-and-white approach.
If patients are concerned by what they find on the database, they can ask their doctor about it, said Dr. Aaron Mitchell, an oncology fellow at the University of North Carolina who has studied how payments influence prescribing behavior.
“It’s definitely worthy of a conversation if a patient is concerned,” Mitchell said. “Within a lot of these subspecialty fields it can be difficult to find a doctor that doesn’t have some level of relationship (with industry). It’s pretty prevalent.”
Many patients, however, aren’t terribly concerned.
Shortly after visiting a specialist at Northwestern on a recent day, Miroslava Arias said she’s heard of the issue and should look up her doctors online to see if they’ve received payments.
But when the 50-year-old Joliet woman visits her physicians, she said her main thought is, “Just try to fix me.”
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