Transparency May Have a Few Downsides for Pharma-Doctor Relationships

By---Terri Bernacchi, PharmD, MBA, Health Advisory Professionals 

I received an interesting alert in my email “in-box” today which was linked to a site called ProPublica.org, an investigative web journalism organization sponsored by the Sandler Foundation (See more about the foundation at: http://en.wikipedia.org/wiki/Sandler_Family_Supporting_Foundation). 

The email I received related to the fact that local news organizations can look up how much money an individual physician in their area may have been paid by specific pharmaceutical companies for consulting or speaking engagements.  In theory, the fact that a physician may become tainted or biased by these moneys is something that we all would want to know about; we don’t want the choice of OUR drug to have been bought and biased but to be the right drug for our medical needs. 

However, the facts could also be distorted or misunderstood to malign a physician who is simply a thought leader for other medical professionals in his area and providing educational support to his colleagues.  These programs are often (but not always) partially underwritten by a pharmaceutical manufacturer.  Physicians, like most people, don’t offer their valuable time for free to structure the presentations or do the projects. 

Continuing medical education has been at least partially underwritten by pharmaceutical and device companies for a long time....certainly long before and since I graduated from Pharmacy School the first time in 1979.  Hospitals and medical schools have finite funds for continuing education -------an essential quality requirement for active staff committed to the need for lifelong learning.  (There’s a reason they call it “practice”...the art is always changing as we learn new things.)

And pharmaceutical and device companies DO want to make sure real world practitioners know about evolving trends that cast their products in a favorable light.  However, I have never met a SINGLE professional who is swayed by these programs or the company underwriting them.  When presented, the evidence is shown in a pretty unbiased way, usually, or the speaking physician will endure the snubs and contempt of his audience.  And they won’t come to his programs if he is a shill for the pharma company.

Seven drug companies, including Eli Lilly, GlaxoSmithKline, AstraZeneca, Pfizer, Merck, Johnson & Johnson, and Cephalon have already publicly posted payments to physicians by name and location.  These companies have started posting in anticipation of new regulations: the Physician Payments Sunshine Act requires all US pharmaceutical, device, and biotech companies to disclose all payments over $10 to physicians beginning in 2013. (Read more about the regulation at Kaiser Health: http://www.kaiserhealthnews.org/Stories/2010/April/26/physician-payment-disclosures.aspx  )

The ProPublica group has taken these public postings and created a searchable database to allow “look ups”; the engine includes a place to enter the doctor’s name but also the state. (See: http://projects.propublica.org/docdollars/ )  (Note:  A simple use of a ‘%’ wild card in the doctor’s name box allows you to pull all physicians and payments for the selected geography or for all 30,342 entries.)  

The site has promoted its database to local newspapers so that they can do stories that will “inform” but probably also embarrass some of the very thought leaders that pharmaceutical companies work with to research diseases or bring products to market through active professional interchange.  The industry cannot do this without the participation the medical community and the medical community cannot cure disease without drugs. Of course, we could always conclude that we’ve solved all of our problems and close down the pharmaceutical and device industry. 

While I found the information posted on this site very easy to use, and I believe it to be accurate, I’m not sure if I can conclude anything relevant after having reviewed it for my area.  The names that appear include some folks that are unknown to me.  But I also recognize some leaders from our local Medical Schools and people that have ethics that I personally know are beyond reproach.  Some of them, in fact, have been hostile to the pharmaceutical industry in the past!  

Certainly, there have been findings that are discussed by the ProPublica group involving a small subset of stipend recipients with a history of licensing sanctions.  This may indicate that Pharma needs to better vet their speakers.

At a minimum, the readers of this blog can become informed of the potential uses of information supplied in the name of transparency.  I am afraid one of the unintended consequences of some of this may be, however, a new wet blanket on the funding and support of local continuing education programs, at a time when the budgets of hospitals and medical schools will become ever more constricted due to Health Care Reform and our anemic economy.

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets.  The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.