With the number of drug and devices companies who disclose payments to physicians for a variety of activities (education, speaking, consulting, and research) growing, some are beginning to question whether such transparency, coupled with the new sunshine law, “promotes enough transparency about potential conflicts of interest.”
When companies began disclosing such information and the Physician Payment Sunshine Act passed, many believed it “would allow patients to become more informed and the profession as a whole to be more transparent.” Policymakers have long asserted that it is crucial that patients are aware of such payments because the potential conflict of interest they create could eventually lead a doctor or health care provider to make a biased decision. So it becomes the responsibility of the patient to determine whether bias or conflict exists.
Joseph Ross, MD, an assistant professor of medicine at Mount Sinai Medical Center who studies conflict of interest issues in the medical field, told Neurology Today that he hopes the new legislation will change the way doctors and industry practice together, and that “instead of focusing on marketing and sales, the legislation is more about physicians working with industry to work and develop better products.”
That is the essence of all physician-industry collaboration: working together to discover better ways to make people healthier.
Giving the perspective of a physician who works with industry and discloses his relationships regularly, Michael A. Williams, MD, medical director of the Berman Brain & Spine Institute at Sinai Hospital of Baltimore, noted that disclosing the information will only reinforce that the relationships between physicians and industry “serves both the public and medicine well.”
When Dr. Williams gives talks, he always makes a conflict of interest disclosure, including the companies he works with, and asks the audience to inform him if they feel there is any commercial bias in his presentation. The Accreditation Council of Continuing Medical Education (ACCME) requires such statements from presenters and speakers, and under their Standards for Commercial Support, also require that industry have no control over the content speakers use during accredited programs.
Consequently, Marjorie Powell, senior assistant general counsel to the Pharmaceutical Research and Manufacturers of America, pointed out that payments from industry are not the only factor. She asserted that “pharmaceutical interest is only one of a number of influences on doctor prescribing practices, including what the insurance companies pay for and what their peers do.”
This distinction is important to recognize because payments to doctors from pharmaceutical companies are critical for the progress and continued innovation in medicine because the industry works with doctors to improve products. As a result, she warned that publicizing such payments as gifts, when they are in fact consulting or other business related activities could be discouraging to physicians.
In pushing for more transparency in physician payments over the years, Dr. Williams explained that we have now “put the tools into the hands of other people to decide if the conflict is significant.” So then, shouldn’t we let patients decide if there is something wrong with doctors working with industry to develop new devices, study new treatments, and find cures for diseases? It’s their health, so they should choose, right?
As Dr. Williams explained, it doesn’t bother him when patients do ask him questions about his work with industry. When he discloses his involvement, although some patients just say “Well, that’s OK,” he said some ask “Does it make you blind to other treatments.” He recognized that some patients do understand the issue of whether a conflict of interest can cause a physician consciously or unconsciously to make decisions they wouldn’t make otherwise.
To that effect, it should be up to the patient first to make that determination. We should not be enacting policies and regulations that prevent doctors from even engaging in such relationships before patients have even had the chance to ask their doctors about their work with industry. If you were a patient, and wanted advice about treatment, wouldn’t you want to at least try something first your doctor had worked on or researched or had experience with? If you need a pacemaker or stent, would you want a surgeon who’s never seen the device until he opens it while you’re on the operating table?
Ultimately, the overwhelming majorities of physicians are honest and open about their relationships with industry, and the Sunshine law and company websites make that even more so. In the past, patients did not ask these questions or were concerned with such relationships, and now, patients barely have enough time with doctors to ask about their own health problems. What has happened is that a few exceptional cases the media has covered brought such payments into a negative light. But now that the “Sunshine” is bright, it’s up to the patients to determine what’s in their best interest.
That means before we continue allowing the relationships between physicians and industry to be harmed and prohibited, we need to have more research on the impact the publication of such payments will have on patient trust in medicine and their doctors. If the trust in the medical profession remains high, as it does presently, then it’s obvious patients recognize the true value collaboration with industry provides to the training of their doctors. If trust is low, we must identify reasonable ways to manage such conflicts without the extreme approach of just eliminating them all together.
Like you, I am a strong supporter of physician-industry collaboration for its vital role in advancing medicine and improving patient care. I agree that “the overwhelming majorities of physicians are honest.” They are also incredibly busy and productive in their clinical, research and teaching roles. The vast majority of physicians, however, are neither bean counters nor compliance experts.
Unlike individual physicians, the medical industry has invested heavily in compliance resources. As industry disclosures of physician payments increase, we can expect to see more studies like the one recently completed by Columbia’s Center on Medicine as a Profession and published in Annals of Internal Medicine. If the results are similar, we can also expect to see more headlines like MSNBC’s “Docs failed to disclose big payments to journals.”
Expect to see frequent audits of physician disclosures. Omissions, misinterpretations and errors in physician disclosures will “continue allowing the relationships between physicians and industry to be harmed and prohibited.” To keep trust in the medical profession high, physicians must work proactively to develop a disclosure system that more accurately describes their relationships with industry.