Distribution of industry-sponsored research payments to US physician principal investigators

Background: The Open Payments program (OPP) was launched in 2013 following the passage of the Physician Payments Sunshine Act (PPSA) to promote transparency of physician-industry financial relationships. Extensive research has scrutinized general (non-research) payments from industry to physicians. However, industry-sponsored research payments (ISRPs), the largest payment category by value in the OPP, are relatively understudied. We characterized the distribution of ISRPs to US physician principal investigators (PIs) across medical specialties. Methods: In this retrospective, observational study, we used publicly-available data from the OPP database to identify cash-or-equivalent ISRPs to physician PIs during 2016–2022. We stratified ISRPs by recipient types (to physician PIs directly and indirectly via teaching hospitals and other organizations referred to as non-covered entities [NCEs]). Our primary outcome measures included ISRP distributions by medical specialties of physician PIs. Secondary measures of interest included identifying medical products associated with the highest total payment amounts. Results: During 2016–2022, ISRPs to physician PIs totaled $33.9 billion, with most ($26.6 billion, 78.5%) directed to physician PIs via NCEs, rather than teaching hospitals or directly to physicians. Physician PIs receiving the highest total payment amounts were general internists, hematologist-oncologists, and neurologists. Anti-cancer drugs, particularly immunotherapy agents, accounted for most of the 25 products associated with the largest payment amounts. Conclusions: This study revealed significant industry payments in physician-led research, particularly in oncology. Furthermore, the study highlights a need for improved research payment disclosures. OPP reporting rules do not require specific disclosure of payments for research expenses versus physician compensations within an ISRP, nor specific products investigated in industry-sponsored research of experimental products. Improved disclosures will promote transparency of physician-industry financial relationships as originally intended by the PPSA.