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Revealing industry payments to docs could spur legislation on conflicts: experts


By Joe Carlson
Posted: March 31, 2014 - 7:00 pm ET
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The public will learn for the first time this fall exactly how much their doctors are paid by the drug companies and devicemakers whose products they use. But don't expect it to be the end of the inquiry.

More than 80% of U.S. physicians receive payments of some kind from drug companies, according to recent research summarized by Harvard health policy professor Eric Campbell. "Financial relationships are incredibly frequent," Campbell told a roomful of reporters Friday at the Association of Health Care Journalists annual conference in Denver. "It is almost difficult to find physicians who don't have relationships."

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Despite the ubiquity of the payments and their potential to cause doctors to steer patients toward heavily promoted products, this September will mark the first time that the public will have access to a searchable database showing who's paying whom. The disclosures are mandated under the Physician Payments Sunshine Act provision in the Patient Protection and Affordable Care Act.

Rather than quenching public desire for the data, however, experts say the release is likely to lead to further action. That could include legislative proposals to curb potential conflicts of interest revealed in the data, as well as tightening rules on how the information is reported.

That's because the ongoing debate on limiting the influence of corporate money hasn't produced a consensus on what the public ought to know.

"Disclosure has become a bare minimum to managing conflicts in medicine," Susan Chimonas, a Columbia University researcher who studies physician-industry relationships, said during an AHCJ session Saturday morning. "The only thing that everyone can agree about right now is that we should know what's going on."

The reform law requires companies to publicly disclose any payments or "transfers of value" to doctors of $10 or more annually, beginning with 2013 data. Companies are already submitting aggregate data, but physicians are supposed to have the chance to fact-check the information before the public can see it, starting Sept. 30, at the CMS' Open Payments website.

Drug companies are likely to report payments to doctors for clinical research, consulting, speaking engagements and informational meetings that typically take place over meals. The CMS also issued rules saying the companies must report the fair-market value of textbooks and journal articles given for free to doctors. Those journal article "transactions" may actually end up making up "a significant portion of what will be reported," said Kendra Martello, deputy vice president of strategic operations for the industry trade group Pharmaceutical Research and Manufacturers of America.

"Physicians are not being paid to prescribe certain drugs. I want to make that clear," Martello said at the health journalists' conference.

Minutes later the same crowd heard Campbell, the Harvard expert, say researchers have documented correlations between industry payments and prescribing patterns. In fact, smaller payments like dinners "work better" than large gifts because they create a nominal sense of gratitude without raising the kinds of suspicions that a large chunk of cash would.

"Does anybody really believe that companies would spend millions of dollars on these things if they didn't work?" Campbell said. "Companies are smart."

But even he acknowledged that the disclosure of a payment doesn't, in itself, reveal whether its purpose was illegitimate—a fact lamented by those who will be named on the Open Payments website.

"It seems to me that transparency has morphed into a form of bias," said Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia. "Everyone gets painted with the same brush."

Offit noted in a different session that his hospital has received money from the drugmaker Merck. He said the money consisted of royalties paid for the RotaTeq vaccine, which was developed at his hospital and sold to the drugmaker. In the past he has declined to say what share of the royalties went to him personally.

Chimonas countered Offit's argument by recalling the case of Dr. Charles Nemeroff, who secretly accepted more than $800,000 from drugmaker GlaxoSmithKline while managing a $9.3 million study on depression at the National Institutes of Health. GSK is the maker of the popular antidepressant Paxil.

"Unfortunately, those guys have poisoned the well for you," panelist and former Boston hospital CEO Paul Levy told Offit. "Life just isn't fair."

Follow Joe Carlson on Twitter: @MHJCarlson


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