This month, Pfizer agreed to pay $60 million to settle allegations without admitting wrongdoing that it had long maintained a system of bribing doctors in eight countries to prescribe its drugs. In July, GlaxoSmithKline agreed to pay a record $3 billion in fines and settlements in an agreement that included the corporation pleading guilty to misbranding drugs by publishing misleading medical research and paying influential physicians to promote off-label uses.
Dr. John Santa, a former internist who is director of the Consumer Reports Health Ratings Center, said physicians who take money to allow drugmakers to boost sales through inappropriate means should be held accountable, especially if they work for the manufacturers directly or as highly paid “de facto” employees.
“It's bad for the profession,” Santa said. “And the profession needs to realize that doctors who do inappropriate things and, as a result, make a lot of money should be held to criminal standards, whether they do it individually or in a company.”
Santa said that even the doctors who lend their influence to a drug company by publicly reciting marketing points ought to share blame when problems with the drugs turn up: “They're doctors that other doctors listen to. And in my mind, that is a (group) that we don't hold accountable. In part, we haven't known who they are. We are going to know who they are now.”
In 2008, HHS' inspector general's office started including requirements in corporate integrity agreements with large drug companies that any and all payments to doctors be publicly disclosed on their websites.
Two years later, a similar requirement was enshrined industrywide in the Patient Protection and Affordable Care Act. Known as the Physician Payments Sunshine Act, the reform provision kicks in March 31, 2013, and will require all drug companies and devicemakers to disclose payments to doctors. Those disclosures will be published online annually, according to the law.
Mary Riordan, a senior counsel to HHS' inspector general's office who has helped write corporate-integrity agreements with several large drug companies, including GSK's in July, said public disclosures may lead to patients questioning their physicians' financial arrangements with drugmakers.
“And sometimes those are perfectly legitimate relationships for a doctor to have with a manufacturer,” Riordan said. “There are other situations where the relationship between the doctor and the manufacturer is suspect.”
Experts say large companies offer much more attractive targets, financially and in the pursuit of the wider goal of changing industry practices. Companies may also be easier to dig up incriminating evidence against, and they may actually tend to want to settle a case faster because the professional damage to a corporation may not be as severe as to an individual doctor.
Riordan acknowledged that she has heard representatives for pharmaceutical companies grouse about the lack of cases filed against doctors when manipulation of medical judgment is alleged.
“My response to that is typically, if there is a doctor you'd like us to look at, give us a name,” she said.
Spokespeople with the American Medical Association and the Pharmaceutical Research and Manufacturers of America did not return requests for interviews.