Transparency as a Powerful Tool illustrating Collaboration and Empowering Patients

Continuing their “Campaign of Shame,” the so-called “investigative journalist” shop ProPublica has been running a series of articles in national and local media sources.  In a recent LA Times article, the reporters told readers that, “patients should know if their doctors get paid by drug firms.”

They try to paint a picture of patients wanting to know whether their doctor is paid by industry to consult, teach, research, or develop a product.  They believe that knowing this information is important because “many brand-name drugs are wildly expensive, and some carry an array of dangerous side effects” and “sometimes similar drugs, either those made by competitors or generics, are cheaper or have fewer risks.” 

Of course, the authors clearly ignore the fact that over 75% of drugs used today are already generics.  Moreover, they clearly ignore the fact that brand name drugs are not what is making American health care so expensive, since drugs only account for 10 cents out of every dollar.

Nevertheless, the authors point to “a recent string of scandals that has raised questions about whether patients need to know more,” particularly because pharmaceutical and medical device makers have paid billions of dollars to settle accusations of kickbacks to doctors and improper marketing of their products.”

The authors recognize that physician-industry collaboration leads “to new and more effective medications, life-saving innovations and a better-educated profession.” Yet they take issue with the fact that these “relationships also can cause physicians to — consciously or not — downplay side effects and poor research outcomes.”

Accordingly, the authors promote their Docs for Dollar database so “patients can learn about their doctors’ financial ties before they are in the exam room.”  Even though there were hundreds of thousands of doctors listed on this database, the authors make sweeping generalizations and statements to convince readers that any doctor working with industry is inherently unethical. 

They claim that, “Many of the doctors who received the most money hadn’t published much in the way of research, and many didn’t have associations with academic medical centers. Some had no credentials beyond a medical license. And some had been sanctioned for misconduct by their home state medical boards.”

What is even more shocking about this reporting is that the “journalists,” who have no medical training or health background—other than trying to discredit hardworking physicians—tell patients to ask their doctors about other drugs, side effects, and even if non-drug solutions should be tried first.  Can you imagine, journalists giving you medical advice?  These are the same journalists who have papers to sell, deadlines to meet, and their own personal missions as well as supporting those of their funders (i.e. Pew).

PhRMA’s Response to ProPublica

Consequently, Diane Bieri, executive vice president, general counsel for the Pharmaceutical Research and Manufacturers of America (PhRMA), gave a firm response to ProPublica’s article.

She first noted how “transparency is a powerful tool and that framed properly to illustrate the collaboration between America’s biopharmaceutical companies and physicians, it can empower patients to become more engaged in the care they receive.”

But she also recognized that “transparency can also lead to misinterpretations, discouraging even the most ethical, unbiased doctors from future collaborations that could improve patient health.”  This is what the “journalists” at ProPublica have done.
 
As Ms. Bieri correctly points out, “by listing only names and compensation figures with limited context, patients may assume their care is compromised by tainted doctors.”  The reality is, “such an incomplete picture creates unnecessary confusion and, in most cases, is completely unfounded.”

PhRMA agreed with ProPublica that patients should know that many physicians work with biopharmaceutical companies.  To be completely transparent, however, they should also know why it benefits them and how the relationship is closely managed to ensure it remains ethical.
 
From consulting on research to helping other physicians learn about the most up-to-date clinical data, physicians play a productive role in America’s biopharmaceutical ecosystem. Company-sponsored peer education programs, for example, allow expert physicians to engage their fellow healthcare providers and exchange the latest FDA-regulated data on new medicines, new uses of existing medicines and new safety information. For their time away from their practices, these physicians are reasonably compensated.
 
Likewise, representatives from biopharmaceutical companies can provide important information to physicians, whose daily schedules of back-to-back appointments with patients leave little time available to discuss new medicines. In some cases, companies provide informational presentations to physicians and their staff during one of the few free moments of their busy days: lunch.
 
Access to this information is essential for physicians, who juggle the demands of patient care with the need to stay aware of ever-evolving science. Last year alone, 21 new medicines were approved by the Food and Drug Administration; patients deserve doctors who are well versed on these cutting-edge medicines as they become available.
 
According to recent research, these programs work. A survey by KRC Research, found that roughly three-quarters of physicians attend peer speaker programs, including 86% in rural areas where physicians would otherwise have limited access to professional development opportunities. Nine out of 10 attendees reported that the information they received was up-to-date, useful and reliable, and more than half said they often gain knowledge or skills helpful to their practice.

These speaker programs complement other sources of professional education, such as medical association-led conferences, by facilitating physician-led exchanges of the latest regulated information about the benefits, risks and appropriate uses of medicines.
 
Importantly, the doctor-biopharmaceutical company relationship also allows companies to obtain on-the-ground information from physicians more easily, helping companies to target future research and respond to treatment gaps.
 
Bieri noted that “while ProPublica and the critics they cite imply that physicians are influenced —  consciously or not — to make judgments not in their patients’ best interest, the KRC survey found that physicians factor many considerations into their prescribing decisions, including clinical practice guidelines, a patient’s financial and insurance status, and, of course, the patient’s health, including drug interactions and side effects.
 
Moreover, Bieri asserted that PhRMA stands by the quality of these ethical relationships and, therefore, supports transparency. She noted that PhRMA understands that patients may want to know if their physicians collaborate with companies, and they should also understand how their care improves as a result. That is why PhRMA supported the physician payment sunshine provisions of the 2010 healthcare reform bill, which will require companies to report payments for services or other transfers of value to physicians, with the government posting this information on a public website.

She noted that PhRMA eagerly awaits regulations on how to proceed with implementation. Companies also comply with internal policies, FDA regulations and the PhRMA Code on Interactions with Healthcare Professionals, which includes details specific to peer speakers’ medical expertise, reputation and experience. These relationships are closely monitored to ensure they remain informative and ethical.
 
Unfortunately, Bieri recognized that “ProPublica’s Dollars for Docs series — the name alone is enough to convey the sensational nature of the material — threatens to potentially undermine the ultimate goal of these interactions: strengthening patient care. The fact is, ProPublica’s series would not be possible if many companies were not already being transparent about relationships with physicians.”
 
Ultimately, she noted that, “the lesson is clear. Rather than be alarmed, patients should take pride in their doctors serving as part of a vast team of scientists and physicians who closely monitor the medicines they prescribe, share findings with healthcare peers and offer feedback to biopharmaceutical companies. The collaborative relationship between doctors and the biopharmaceutical industry ensures that cutting-edge treatments will continue to enhance patient care.”