In response to all of the conflict of interest allegations between industry and physicians, Eli Lilly and Co., recently released a list of payments made to them in an effort to be more transparent about its dealings with doctors. The list is "consistent with Lilly's efforts to increase transparency," Vice President Jack Harris said in a statement.
The local media (Miami Herald, Wichita Eagle, Pittsburg Business Journal) which has covered this announcement has been singularly focused on funds received by local physicians versus the value that those relationships provide patients. There is also no shortage of “ethics experts” who will gladly add comment in the press (having been ignored by their colleagues and media for most of their careers, who have little ties to actual patient care, clinical research, or educating practicing physicians).
The pharmaceutical company's list covers the first quarter of 2009 and includes five individuals and two medical practices in that received a combined total of nearly $30,000, mostly for educating other physicians. Also on the list were 10 providers who reported more than $10,000 each during the first quarter. At least one of those physicians is a world class lung cancer researcher who is working tirelessly to develop new therapies for patients with little chance of living.
In order to be transparent, Eli Lilly has created an online registry detailing payments to 3,400 healthcare providers — including more than two dozen providers in in the first three months of this year. These payments, however, are perfectly legal and represent legitimate sources of income for physicians similar to expert testimony.
Although critics of such industry funding, such as Senator Herb Kohl (D-WI) believe that “large corporations do not typically spend these sums unless they think they will get something out of it,” are being overly critical of physicians providing useful services in training and consulting.
What more do these politicians want other than public disclosure of the money? It is now up to the patients to decide whether the treatment they are receiving could possibly be biased. We know that it is not because physicians engage with industry to benefit patients.
“In most of the cases, the website — Lillyfacultyregistry.com — reported that the doctors had earned their fees by speaking at professional education seminars. A few received sums for educating patients or consulting.”
Many of the doctors listed have commented that their activities and lectures always stay within the Food and Drug Administration guidelines for the drugs, and that Lilly's payments would “absolutely not” influence their decisions on what drugs to prescribe for patients.
The problem, however, is not necessarily with the website itself, rather, it is how the media portrays to the public the information contained on the website. It appears that local news and media only want to say is that “oh, this doctor got paid this much money.” What local news and media intentionally fail to talk about is exactly what that money is being paid for. While an overwhelming majority of the published fees for physicians are well under $10,000, that value is extremely easy to understand considering the significance such fees represent.
When a physician is asked to speak in front of other physicians, academic and medical organizations, it is often to instruct doctors of new breakthroughs in research, clinical studies, new medicine and devices, as well as evolving standards and regulations. If it were not for many of these events, which the doctors are rightfully paid for their time—as is any lawyer, lobbyist, or business person—patients and society would suffer.
Moreover, by the media just publishing what a specific doctor received, it labels them as conflicted without even giving the full side of the story. News coverage needs to be more neutral, and convey a holistic approach to reporting already public information, instead of twisting it to sell papers or get attention. While we always prefer more disclosure for interactions between industry and physicians, a scarlet letter is unnecessary, and will only confuse patients more.
The goal of transparency is to help consumers, employers, insurers, and others to make informed decisions, since “every market where health data is shared, performance improves,” according to one source.
This disclosure system represents the true efforts of industry to educate physicians about new products, and physicians educating other physicians. Lilly should be applauded for its leading step, and other industries should follow. On the other hand, local media needs to fully explain not only what physicians are getting paid, but also a list of other things, including, but not limited to:
– The services provided by the physician (e.g., speaking, consulting, research);
– Travel expenses, meals, and other associated expenses; and
– The potential impact their services will provide to physicians and patients.
In the end, when physicians are explaining to physicians what treatments and options are available for them, physicians are ethically and legally responsible to tell them all of the potential risks, benefits and costs, as well as any experience in performing or prescribing a certain recommendation. The local media needs to follow the same set of ethical and legal guidelines by producing all information, not just the bias they represent.