"Find Out If Your Doctor Takes Drug Company Money"
The long-time editor of a prestigious medical journal
started his editorial on physicians’ conflicts of interest
describing a fantasy that doctors treat patients using simply
the best evidence and experience rather than being influenced
by money or self interest.
This... is of course, nonsense.
There is a reason pharmaceutical companies spend billions of dollars
on the influencing, education, and entertainment of
doctors around the world.
The vast majority of physicians in the United States take gifts
from the pharmaceutical industry,
and ironically cardiologists, whose practice centers around diseases
that can be largely be prevented and treated with lifestyle changes,
receive the most payments of all.
A previous compilation of surveys from the 80s and 90s found that,
on average, doctors met with drug industry representatives
face to face about once a week.
Today, your family doctor may meet with drug company employees
on average, 16 times a month.
Wait a second! There’s only 20 workdays a month,
So that’s nearly every day.
What does the public think about this?
Only about half even appear to know what’s going on.
So if 83% of doctors receive gifts,
it is likely that a significant percentage of patients are
not aware that their personal physician receives industry gifts.
And we’re not just talking like a Viagra paperweight or soap dispenser.
For marketing, pharmaceutical companies spend $15,000
per physician every year, making conflicts of interest
one of the most pressing problems in American health care.
How do doctors feel about it?
Most generally approve of the gifts, however,
tellingly, physicians do not want gift relationships made public.
Physicians disagree that it is inappropriate to accept gifts,
but their reluctance to disclose this gift relationship to the public,
suggests that they must recognize that the public
would not appreciate the practice.
To analyze how physicians resolve this contradiction,
researchers conducted a series of physician focus groups.
It turns out physicians use a variety of denials and rationalizations;
they avoided thinking about it, denied responsibility…
Physicians readily acknowledged the inherent conflict of interest,
but this didn’t stop them;
in fact some complained that the gifts were getting more modest.
Us doctors tend to deny that we personally have any conflict of interest
if a pharmaceutical company buys us a nice dinner, for example.
We tend to insist that it won’t affect our judgment in any way,
as if drug companies just like wasting money on purpose.
Most physicians contend that their colleagues are susceptible
to the industry’s influence but not them.
Though physicians don’t want these gift relationships to be public,
that’s just too bad, because thanks to Republican Senator Chuck Grassley,
the Sunshine Act was inserted into Obamacare and so for the first time,
patients will now be able to see what, if any,
financial ties their own doctor has.
Doctors can’t hide anymore.
This will give patients some insights when choosing a provider
and once the database goes live, law enforcement agencies
can also see who’s getting money from industry
to investigate illegal kickback cases.
Right now it might just be embarrassing,
but this could allow attorney generals to go after doctors
to see the kind of incentives they may be getting for writing
a lot of prescriptions.
And the database is live right now.
If you go to openpaymentsdata.cms.gov/search
or for a more user-friendly version, Propublica’s Dollars for Docs page.
The drug industry spends billions trying to influence doctors
and for the first time you can see if your physician,
or any physician has their hand out.
Senator Grassley hoped that this would help save our nation money.
It could reduce healthcare costs if patients view
such doctors less trustworthy,
or choose doctors less in bed with industry
or could change physician behavior, who may want to avoid
financial relationships with companies
to guard against this patient distrust
or becoming the target of an exposé or investigation.
Or they could just try to cover it up.
This is from the American Academy of Family Physicians,
advising physicians how to avoid getting burned by the Sunshine Act.
For example, drug companies now have to report when they give
doctors free meals valued at over $10.
So should family physicians just stop accepting free food
from drug companies?
No way—you just have to give the drug sales reps
the right head count so the meal cost dips below $10 per person.
The former long-time editor of the
New England Journal of Medicine said it best.
"Although the spotlight has been on disclosing doctor’s
financial relationships with industry,
the problem with conflicts of interest is not the lack of disclosure,
but the existence of the conflict itself.
Rather than just disclosing them,
the best approach to financial conflicts is to have none."