Daniel Carlat Discusses How Disclosure Can Address Doctors Conflict of Interest

Over the years, we have seen increased criticism of physician-industry relationships and collaboration, with critics claiming that such relationships create the potential for conflicts of interest.  In 2010, in an attempt to make such relationships more transparent, Congress passed Section 6002 of the Affordable Care Act (ACA)—also known as the Physician Payment Sunshine Act (“Sunshine Act”).   

This section requires medical products manufacturers to report certain payments over $10 they make to physicians and teaching hospitals in an attempt to “shine some light” on such relationships so that consumers and the public are informed of their healthcare providers interests.   

Despite most stakeholders in the healthcare industry sharing unanimous support for increased transparency, there has been disagreement about how best to implement the Sunshine Act.  Additionally, there are still a small group of critics who believe that public disclosure of such relationships is simply not enough, and that all interactions between physicians and industry that involve some financial remuneration should be banned.   

Recently, however, we have seen some of these critics taking more of a middle ground and reasoned approach, which recognizes that physician-industry relationships are positive and benefit patients and lead to medical progress.  Specifically, a recent article from Daniel Carlat, MD, Director of the Pew Prescription Project, recognized that “Disclosure can address doctors’ conflicts of interest.”  Carlat himself worked with drug companies for several years, educating physicians.  Carlat also recently spoke at the Sunshine Roundtable hosted by the U.S. Senate Special Committee on Aging.

Carlat emphasized that “Monetary relationships among doctors and drug and device companies are not inherently bad; in fact, they are crucial for advancing medical research and patient care.”  Although he recognized the potential for such relationships to “skew prescribing practices and research results,” he maintained that “transparency and education” are an “elegant solution” to these problems.  Specifically, he asserted that transparency and education “allow these often important relationships to exist, but only on the condition that other professionals and patients are fully informed about them.” 

Ultimately, Carlat’s recognition that physician-industry relationships should be maintained so long as they are transparent and patients are educated about them is a reasonable approach to preserving the innovation and progress such relationships produce.  It is with reasoned leadership and logic by stakeholders such as Pew that the Sunshine Act may have a chance of being implemented in a way that minimizes the risk of chilling innovation and hurting patients.

Despite
his recognition that disclosure may be useful, the cost of transparency
and its unitended consequences should not be so easily forgotten.
Regulations such as the Sunshine Act will spawn a new “transparency
industry” dedicated to squeezing millions of dollars out of companies to
comply with this law–money that could be spent on research and finding
cures for treatements for cancer and diabetes.  It will be critical moving forward that the context of these disclosures is made fully available to the public so that such transparency does not chill innovation and ultimately harm patients.