Drug firms release payment information

Excerpted from “Drug and device firms paid $3.5B to care providers,” Associated Press. September 30, 2014 — Drug and medical device companies paid doctors and leading hospitals billions of dollars last year, the government disclosed Tuesday in a new effort to spotlight potential ethical conflicts in medicine. The value of industry payments and other financial benefits totaled nearly $3.5 billion in the five-month period from August through December 2013, according to the Centers for Medicare and Medicaid Services, which released the data.

It's part of a new initiative called Open Payments, required by President Barack Obama's healthcare law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn't fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said.

Consumer groups said it's a step toward much-needed transparency. But doctors and industry said the government rushed to release the data, and they raised questions about accuracy and lack of context.

The American Medical Association said it remains "very concerned" about release of the payments file, adding that the data may contain inaccuracies and lacks context to help the average person evaluate the information. Consumer groups say disclosure is overdue. "Research has shown over and over that these financial relationships influence doctors, even a meal," said John Santa, medical director for health projects with Consumers Union. "Studies also show that doctors believe it does not affect them, but strongly believe it affects other doctors."

Commentary

CMDA Member John Dunlop, MD: “Wow! $3.58 billion spent by pharmaceutical and device manufactures to directly influence physician choice is an impressive amount. I naively thought that these payments and gifts went out with the free lunches and logos on pens several years ago. It appears that those restrictions do not have much substance and thus the potential for ethical abuse persists as a real threat. The number comes from the website “Open Payments,” a project of Obamacare intended to bring accountability to the heretofore undisclosed inducements given by industry to practicing physicians. It should be noted, however, that just two days after this article was released, another article pointed out many potential flaws in this data.

“As Christians, when faced with the possibility of receiving incentives from industry, we must remind ourselves that our primary responsibility is not to make money but to provide the best, compassionate and cost effective care to our patients. In Proverbs 19:6, Scripture warns that receiving gifts influences our behavior, and this may be true even when those gifts do not obligate the recipient to prescribe the products involved.

“The CMDA Ethics Statement on Doctor & Pharmaceutical/Medical Device Industry Relationships states the ethical principle: ‘Doctors should consider carefully the basis of their therapeutic decisions to assure that they are made in accordance with best possible evidence applied to the welfare of the patient. Personal gain must never be the compelling reason for our decisions. Incentives from industry, intended to influence therapeutic choices, can compromise doctor integrity and behavior.’”

Resources

Christian Physician’s Oath
Doctor & Pharmaceutical/Medical Device Industry Relationships Ethics Statement
Professionalism in Peril - Part 3: Professional Adultery

Task Force: Ban Drug Reps From 'Ivory Towers'

Excerpted from Task Force: Ban Drug Reps From 'Ivory Towers' MedPage Today. December 11, 2013 -- Drug sales reps should be banned from academic medical centers, but mingling between faculty and pharma researchers is not a problem, according to a conflict-of-interest task force.

"Pharmaceutical sales representatives should not be allowed access to any faculty, students or trainees in academic medical centers or affiliated entities," the task force, convened by the Pew Charitable Trusts, wrote in a 30-page report released in December. "However, faculty may invite pharmaceutical scientists for specific educational or scientific discussions that do not involve marketing of a specific product."

The task force—with representatives from seven academic medical centers, various consumer organizations, the Association of American Medical Colleges (AAMC) and the American Medical Student Association—referenced a review of 29 studies that found physicians who interacted with sales reps prescribed lower-quality, higher-cost drugs compared with non-exposed doctors. Current AAMC policy recommends that sales reps only be allowed on academic medical centers by appointment and that they be prohibited from entering patient-care areas.

Banning sales reps is one of seven recommendations the task force made, all of which would tighten current AAMC recommendations. The conflict-of-interest policies should also apply to training sites such as affiliated hospitals and clinics, the task force recommended. Of the 15 recommendations made, several vary at least somewhat slightly from what the AAMC already recommends to its member schools.

The Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade group, said it was important for the development of new drugs and for patient safety that physicians and drug companies maintain collaborations. “While PhRMA is still reviewing the findings of the Pew Charitable Trusts’ report, it is important to stress the importance of collaborations between biopharmaceutical research companies and physicians, including at academic medical centers,” PhRMA Executive Vice President Bill Chin, MD, told MedPage Today in a statement. “These interactions improve patient care and contribute significantly to scientific innovation.”

Commentary

CMDA Member and Associate Professor of Anesthesiology J. Grady Crosland, MD, MAR: “‘Whatever it is, I fear Greeks even when they bring gifts’ (Virgil’s Aeneid).

“Thus was ‘there is no free lunch’ announced two millennia ago. Men have always expected a quid pro quo. Our fallen human nature leads us into temptation. The question is how do we respond to it? Social scientists say it doesn’t take much to create a sense of indebtedness in those who receive unsolicited gifts.¹ I much prefer to teach virtue ethics as a part of the core competency of professionalism. Make the ‘weaker brother’ stronger and leave personal choice to the individual physician.”

¹Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review. Geoffrey K. Spurling et al. PLOS: Medicine, October, 2010.

Resources
Ethics Statement – Doctor and Pharmaceutical/Medical Device Industry Relationship
Professionalism in Peril