Kaiser Health News: Physician Payment Disclosure and Affects on Physicians and Patients

Although the database of payments to physicians from pharmaceutical and device companies, required by the recently passed Physician Payments Sunshine Act, will not be posted until September 2013, some are predicting that its impact will reduce such payments. A recent article in Kaiser Health News described how the new law will require companies to begin recording any physician payments that are worth more than $10 in 2012 and to report them on March 31, 2013.

Payments include stock options, research grants, knickknacks, consulting fees and travel to medical conferences at hotels.

In comparing the newly passed law with the experience of Vermont, where reporting has been required since 2002, Kaiser noted that the Sunshine Act “may curb the payments.” A report from Vermont’s attorney general showed that total payments to physicians dropped 13 percent in fiscal 2009 to $2.6 million.

While advocates of such laws believe that industry “compensation can affect a doctor's choice of drugs or treatment,” exposing such payments, despite their beliefs will not dissuade such behavior—it will dissuade doctors from working with industry. When doctors, who firmly and rightly believe that their work with industry is legitimate, feel their work is being questioned, patients will suffer, and so will future generations of doctors and researchers.  

Despite the numbers showing that payments have “been going down steadily for the last three years," in Vermont, it is not just gifts that health care providers will not accept. Soon, physicians will not participate in clinical trials, FDA regulated medical education, conventions, and even research. What perception has changed over the past few decades that would force doctors away from collaboration and partnerships that have advanced life spans, lengthened survival rates, provided vaccines, and so much more?

In addition to Vermont, similar legislation in Massachusetts and Minnesota, have also outlawed many forms of corporate gift-giving, although they do allow doctors to accept speaking fees and most product samples, and all three states allow research grants.

Even with the restrictions put in place by the Sunshine Act, supporters believe it will “lower health care costs and strengthen patient-doctor relationships." Without any research or evidence to support this claim—other than using more generics, and brain scans—impeding a physicians freedom to pursue other interests, research, and financial incentives will likely hurt patient-doctor relationships.

This is even more realistic considering numerous doctors are no longer taking patients for Medicare and Medicaid because of low reimbursement, and many are leaving private practice for bigger institutions due to overhead costs and administrative burdens.

Moreover, doctors barely have enough time in the day to squeeze in enough fifteen minute appointments to make due, let alone read journals about new treatments or attend educational programs to learn about different medicines. As a result, if the databases are used by media and critics of industry to characterize the partnership between industry and physicians as negative, there is no question that innovation will be stifled and patients will suffer.

As Dr. Thomas Stossel, the director, division of translational medicine at Harvard, co-founder of the Association of Clinical Researchers and Educators (ACRE) noted, "The use of the term 'sunshine' has an implicit aura of corruption." The reality is, once payments are published, the public and critics will soon begin to realize that there is nothing to hide, and that these relationships are essential for advancing medicine and making people’s lives healthier and longer, as they have for decades.

Regardless of the irrefutable evidence from the past and present regarding the effectiveness and impact industry-physician relationships have created, some feel that payments can create conflicts of interest. For example, Kevin P. Weinfurt, an associate professor of psychology and neuroscience at Duke University, found that patients in clinical trials “were particularly troubled when doctors owned stock in the companies that were managing the clinical trials." He noted that patients “felt somehow that this physician could do something in the trial that could make the company a lot of money, which would then make him a lot of money."

First, without company support, many of these clinical trials would not be possible and patients without access to treatments would be left with no options, and other patients would not benefit from their experience and research.

Second, it’s troubling to think that people may be more concerned with investments into life saving medicines and technologies more than the bankers and traders on Wall Street who put our economy into turmoil.

The fact is, clinical trials are heavily regulated by the FDA and other oversight is tremendous. With a success rate being so low for a drug making it to the market after years of development, and almost a billion dollars, patients in these trials must not have realized that making money is not the goal of the physician—creating a new medicine to help people is.

As a growing number of pharmaceutical companies have already begun posting payments to physicians, the new federal databases inclusion of explanations of what services the physicians provided in return for the payments will be crucial.

As a result, being able to determine whether their doctors are heavily invested in companies will give patients more information to make decisions about their health. It will also “give the public greater confidence in the nature of the relationships" between companies and physicians."