The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment

Abstract

Background: Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties.

Objective: The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry.

Design: This was a randomized experimental evaluation.

Participants: There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study.

Interventions: Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician.

Main measures: Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust.

Key results: Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry.

Conclusions: Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://ichgcp.net/clinical-trials-registry/NCT02179632 ).

Conflict of interest statement

Funders

Financial support for this study was provided by the Edmond J. Safra Center for Ethics, Harvard University, and Brigham and Women’s Hospital Department of Medicine. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Conflict of Interest

The authors declare that they do not have a conflict of interest. The content of this article is solely the responsibility of the authors and does not represent the official views of the Veterans Health Administration, the National Center for Ethics in Health Care, the U.S. government, Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.

Figures

Figure 1

CONSORT study flow diagram

Figure 2

Average trust ratings for individual physicians. Ratings are based on five-point Likert scale (1 = lowest trust, 5 = highest trust). Whiskers represent standard error. Significance indicates that analysis of variance results found differences in trust ratings across payment conditions. *p < 0.05, ***p < 0.001. All analyses controlled for race.