(Rachel Orr/The Washington Post)

This story has been updated.

Doctors received $6.5 billion worth of payments — including meals, research grants and charitable contributions from drug and medical device companies in the last year, according to new data released Thursday by the Centers for Medicare and Medicaid Services. They also owned a little over $1 billion in stock in the industry.

The financial relationships between 618,000 doctors and 1,110 teaching hospitals and nearly 1,500 companies are required to be disclosed under a provision in the Affordable Care Act, often referred to as the "Physician Payments Sunshine Act," because it aims to reveal the breadth and extent of the relationships between doctors and companies.

Drug companies have long argued that such relationships are necessary for education, but critics say these payments are powerful marketing tools that can distort the use of health care in ways that drive up spending or lead to medical decisions that follow a company's commercial interests instead of the best medicine.

The top three companies gave more than $1.4 billion to doctors and hospitals. The biggest giver was Novartis, which reported $539 million in payments. Genentech provided $470 million in payments, followed closely by Pfizer, with $436 million.

A Novartis spokeswoman said in an email that the company thinks "interactions with physicians and teaching hospitals play a critical role in advancing patient care and helping ensure that medicines are being used appropriately."

"Collaboration between physicians and biopharmaceutical professionals is critical to improving the health and quality of life of patients," Holly Campbell, a spokeswoman for the trade organization Phrma wrote in an email. "Physicians also provide real-world insights and valuable feedback to companies about their medicines to improve patient care."

The American Medical Association issued a statement supporting transparency, but warned that verification of the reporting system is fraught with problems, because most physicians have not been able to review or validate the data because of problems with the registration procedure for the system.

"The AMA strongly opposes inappropriate, unethical interactions between physicians and industry.  However, not all interactions are unethical or inappropriate. There are relationships that can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients," the statement said.

According to the release, 0.13 percent of records were disputed by doctors or teaching hospitals.

The data show little change from last year, in aggregate, when doctors received $6.4 billion in payments and owned about $1 billion in stock. But there are some intriguing shifts, including an increase in drug company payments to doctors that were classified as charitable contributions and a decrease in gifts, entertainment, honoraria and other categories that may raise the most urgent questions about conflicts of interest.

“Transparency is empowering physicians to be purposeful about their financial relationships with companies, and there is a notable shift towards charitable contributions and away from other interactions such as honoraria and gifts," Shantanu Agrawal, director of the Center for Program Integrity at CMS, said in a statement.


CMS

The CMS analysis also found that a little more than 637,000 financial interactions between doctors and drug companies were related to opioid painkillers — more than 2 percent of the payments tracked.

The physicians that received the most payments on average were those in nuclear medicine, with the average total payment of $51,279 — followed by neurologists and orthopedic surgeons.