HOW much did your doctor get paid by the drug companies last year? Did he or she have a $20 lunch or receive tens of thousands of dollars in consulting fees? Hopefully your doctor received no payments from Big Pharma but soon there will be a way to know.
This week, following months of pressure from advocacy groups, the Centers for Medicare and Medicaid Services released the rules for a little-known but important segment of Obamacare called the Physician Payment Sunshine Act.
Originally authored by U.S. Sen. Chuck Grassley, R-Iowa, and included as part of the Affordable Care Act, the Sunshine Act requires manufacturers of drugs, medical devices and biologics to report the monetary value of gifts and payments to doctors and teaching hospitals on a publicly accessible website. Implementation of the Sunshine Act is an important step toward curbing the unsavory practice of pharmaceutical companies giving gifts or direct payments to the very same physicians who prescribe your medications.
For at least a half-century, doctors have received gifts from pharmaceutical manufacturers. And for nearly as long there have been cries of professional conflict in this arrangement. In 1961 a blue-ribbon panel of doctors urged the profession to look critically at this practice, stating, “Do all concerned realize the hazard of arousing the wrath of the people by an unwholesome entanglement of doctors with the makers and sellers of drugs?”
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As a medical student, I watched my role models, outfitted with brand-identified pens, notepads, stethoscopes and reflex hammers, getting fed and supposedly educated by drug-company representatives. I ate my way through medical school through the largesse of the drug companies, naively not understanding how a piece of pizza could possibly influence my prescribing practices.
In my professional career I have declined lavish meals at fine restaurants, stuffed animals for my children, pro sports games and theater tickets from those wanting me to prescribe their products. (All offered under the pretense of continuing medical education.) But for years I continued to see drug representatives in my office.
As the number of drug reps knocking on my clinic door increased to nearly 30 per month, it became ever clearer that the agenda was not education but to sell product. At the same time, investigations around marketing tactics revealed internally sanctioned withholding of information by sales reps. Interacting with pharmaceutical salespeople was not in my patient’s best interest and my small practice in rural Oregon closed our doors to drug sales representatives in 2006.
When surveyed, patients take a dim view of doctors seeing drug salespeople. More so than doctors, they clearly see the conflict of interest in the physician-pharmaceutical industry relationship. Patients are rightfully concerned because this type of relationship (often including the acceptance and distribution of free drug samples) has been shown over and over again to increase prescription costs and promote the irrational prescribing of marketed drugs.
Many people think these payments to doctors are a thing of the past. While all-expense-paid junkets to exotic locations have largely disappeared with self-imposed rules created by the Pharmaceutical Researchers and Manufacturers of America, the meals, speaker fees and consulting payments have not. As recently as 2007, 699 doctors in Minnesota received more than $10,000 each in direct payments from drug companies. One hundred twenty-three physicians received more than $100,000 each, according to a 2007 New York Times report.
There is one pharmaceutical salesperson for every eight physicians in the United States and drug companies continue to spend billions of dollars directly marketing to doctors. Despite the consistent evidence that this results in bad medicine, many doctors continue to see drug reps in their offices and accept gifts. Over a nice meal, doctors and their staff are presented with incomplete information from highly skilled salespeople focused on promoting their employer’s products. To shine light on this culture, sunshine laws are necessary.
Fortunately, many academic medical centers have instituted guidelines or outright bans on their doctors interacting with pharmaceutical salespeople, setting a far better example for today’s medical students. Increasingly, individual doctors are saying “no” to meeting with drug representatives and gifts. However, in 2012, those doctors who did accept visits reported two visits per day from the salespeople.
Some physician organizations, such as the National Physicians Alliance and the American Medical Student Association, encourage their members to look critically at their relationship with Big Pharma and provide tools and information to help doctors find reliable, unbiased, evidence-based sources of medical education, which include accessible publications that educate doctors about new drugs and cost-effective generics.
At long last, the Sunshine Act will require drug and medical-device manufacturers to publicly disclose these financial relationships with physicians. This includes the costs of gifts, consulting fees, research activities, speaking fees, meals and travel. Data collection will begin in August and public reporting is expected in September of 2014, about one year later than originally planned.
The Sunshine Act is just one of many provisions in the Affordable Care Act designed to provide clarity in health-care markets. It will most certainly illuminate the financial entanglements of doctors with industry, providing needed transparency to help inform patients of relationships that could compromise their health care.
So how much does your doctor get paid by the drug companies?
With these long-awaited new rules, the Sunshine Act will allow you to find this information with the click of a mouse.
David V. Evans is a family physician with 15 years of private practice experience in rural Oregon. A past president of the National Physicians Alliance, he teaches and treats patients at the University of Washington School of Medicine.