After Massachusetts published the last ½ of 2009 data on industry payments from pharmaceutical and device companies to physicians and health care providers, and ProPublica creating a searchable database of industry payments to physicians, CNN conducted an interview and asked three participants whether drug companies were corrupting physicians.
Speaking from the perspective that physician-industry payments are unethical was Angie Maher, a former Michigan drug sales representative turned whistle-blower, according to an article published last week in the SentinelSource by the Chicago Tribune’s Judith Graham. Ms. Maher was involved in the Johnson & Johnson-OrthoMcNeil settlement in April of this year. The whistleblowers in this settlement will receive payments totaling more than $9 million from the federal share of the civil recovery.
Ms. Maher told CNN’s Sanjay Gupta, who conducted the interview, that she believes that unethical drug marketing is widespread. She said that the practice comes from both ends, and that off-label marketing will always be around, and it is something that both doctors and pharmaceutical companies demand.
On the transparency side of the interview was Charles Ornstein, a senior reporter at ProPublica, who helped published the “Docs for Dollars” project we have been covering over the past several weeks. Ornstein maintained that consumers are the main reason why payments need to be published, and that transparency is a good thing because it gives patients and consumers the opportunity to ask physicians questions about these payments.
Speaking in favor of physician-industry collaboration was Thomas Stossel, MD, professor of medicine at Harvard Medical School and director of translational medicine at Brigham and Women’s Hospital. He is also a co-founder of the Association of Clinical Researchers and Educators (ACRE), a non-profit organization that promotes the advancement of patient care through productive collaboration with industry and its counterparts.
Dr. Stossel explained to Sanjay that he defends physician-industry partnerships because over the past 40 years, medicine has significantly improved because of the tools that industry has provided to physicians. He added that industry has given physicians the tools to improve health and patient outcomes, and physicians who work with industry have been able to teach other physicians how to use those tools. As a result, he asserted that on balance, the value of industry-physician collaboration way exceeds the allegations of corruption.
He welcomed criticism of such relationships however, and did note that transparency is important. However, what Dr. Stossel took issue with is the language critics of industry-physician relationships use to allege corruption. Dr. Stossel recognized that if companies or drug reps were behaving the way Ms. Mehar suggested, that those individuals deserve to be prosecuted. Nevertheless, he explained that the large settlements, such as the one Ms. Mehar was involved in, create problems of public perception.
For example, he explained that companies involved in off-label prosecution have no choice but to settle with the government because otherwise they face debarment and will no longer be able to do business with the government (CMS, VA). Yet, when the individuals who are alleged of wrongdoing are prosecuted, they are usually found not guilty, as Harvey Silvergate explained in his book “Three Felonies a Day.”
Additionally, although Dr. Stossel supports transparency overall, he took issue with how media sources, tort lawyers, and prosecutors are using such information. He argued that frequently, these parties overlook the fact that drug costs are an extremely small percentage of health care costs. In fact, prescription medicines account for only 10 cents of every dollar spent on health care, and while many people consider spending on prescription drugs in the U.S. to be increasing or very expensive, money spent on drugs is considerably less than spending on hospital care or physician services. In addition, chronic disease, which accounts for $3 out of every $4 spent on healthcare, is what threatens the U.S. health care system, not the cost of medicines.
Dr. Stossel’s final comment was that media sources portray industry-physician payments unfairly, when the reality is the overwhelming majority of physicians do not make large or even significant amounts of money from industry. Nevertheless, whatever that amount may be, Dr. Stossel recognized the need for doctors to acknowledge to media sources that, yes, I received X$ from Y company, and I did so because there was value. Otherwise, I would not have taken the time away from my practice, my family, or life to help educate others and advance medicine.