Discussion
Our study revealed that 65.5% of all board-certified cardiologists in
Japan received personal payments for activities such as lecturing,
consulting, and writing from pharmaceutical companies between 2016 and
2019. The total amount of these payments exceeded $112.9 million,
equivalent to approximately 12.3 billion Japanese yen over this
four-year period. Although the level of these payments remained stable
throughout the study period, a disproportionately small group of
cardiologists received the majority of these payments. To the best of
our knowledge, this is the first study to explore the comprehensive
financial interactions between pharmaceutical companies and
cardiologists in a country other than the US.1,2,20
Contrary to findings in the US, where approximately three-quarters of
cardiologists reportedly received various personal payments, including
compensation, honoraria, travel fees, royalties, and food and beverage
payments from pharmaceutical and medical device
corporations,1,2 our research in Japan indicates that
a mere half of the board-certified cardiologists annually received
financial recompense for lecturing and consulting from the
pharmaceutical companies. Although the study findings were consistent
with previous studies in Japan,11,13-17,19,23-25 this
lower percentage of cardiologists in Japan receiving such payments than
those in the US would substantially underrepresent the actual degree of
their financial engagements with the healthcare companies, given that
our study was limited to compensation payments to individual
cardiologists and did not encompass other prevalent payment categories
or payments from medical device companies, despite that cardiologists
frequently utilized medical equipment and devices such as implantable
cardioverter-defibrillators, cardiac catheters, and stents.
Although the majority of cardiologists received only modest amounts of
payments relative to their overall income as cardiologists, the impact
of these payments should not be underestimated. Previous studies in the
United States have demonstrated that even small payments to
cardiologists from medical device and pharmaceutical companies are
significantly associated with increased usage of implantable
cardioverter-defibrillators,8 percutaneous coronary
interventions,26 stent placements,9and prescriptions for oral anticoagulants27 and
antiplatelet drugs.9 Nonetheless, given the absence of
studies exploring the associations between payments to cardiologists and
their clinical practices, future research is warranted to investigate
the impact of industry payments on the clinical practices of
cardiologists in Japan.
Additionally, we found that only a small number of cardiologists
received the vast majority of personal payments. As we elucidated, the
average payments to JCS executive board members12 and
cardiology guideline authors18 were substantially
larger than those received by the board-certified cardiologists on
average. These physicians, often referred to as key opinion leaders, are
frequently targeted by pharmaceutical and medical device
companies,28-37 due to their authoritative and
influential positions.
Given their significant influence on other cardiologists, it is crucial
to properly manage COIs among these influential cardiologists. However,
previous studies have indicated significant undeclared and underreported
COIs between these physicians and pharmaceutical companies in
Japan.12,18,28-30,37 Additionally, the policies for
managing COIs in Japan are less rigorous and transparent compared to
those in other developed countries.28,30,36,37 The
study findings further underscore the critical need for effective
management of financial COIs among influential cardiologists in Japan.
This study has several limitations. Potential inaccuracies in the
payment data reported by companies and in the database may exist.
Moreover, the omission of certain types of payments, including meals,
travel expenses, and gifts, which are not readily available in Japan,
likely leads to a substantial underestimation of the magnitude and
proportion of financial relationships between cardiologists and
pharmaceutical companies in Japan. Furthermore, as the study encompassed
only payments from JPMA-affiliated companies, it may not fully represent
the entire range of financial interactions between cardiologists and
pharmaceutical companies not affiliated with the JPMA and medical device
companies.
Despite these limitations, our study demonstrates that more than 65% of
cardiologists certified by the Japanese Circulation Society received
personal payments related to lecturing, consulting, and writing from
pharmaceutical companies between 2016 and 2019. These payments were
concentrated among a small group of cardiologists. Future studies should
explore the influence of these payments to cardiologists on their
clinical practice in Japan.