One of the National Physicians Alliance’s guiding principles states: “We place the best interests of our patients above all others and avoid conflicts of interest and financial entanglements. The health of our patients is our first concern.” One of the most evident examples of fulfilling this commitment is the Unbranded Doctor campaign, which aims to remove pharmaceutical company (PhRMA) influence from physicians’ practices.
There are arguments made that not all PhRMA influence is harmful. Some argue that medication samples provide benefits and allow patients to save money. Others–often physicians–claim that speaking on behalf of PhRMA allows them to discuss the benefits of certain medications and treatments (even though deeper investigation indicates that employing physicians as speakers may simply provide another avenue for PhRMA to change phycisians’ prescribing patterns). However, there is research that physicians can be influenced by PhRMA and other industry contacts, and that this influence might not be noted by the physicians themselves. Now, there is a more direct reason for physicians to avoid PhRMA payments: they undercut patients’ trust.
ProPublica and Consumer Reports carried out a survey investigating patients’ perspectives regarding physicians who accept PhRMA payments. The survey indicates that patients are largely unaware of the nature of physician/PhRMA contacts, and 74% of survey respondents disapprove of physicians taking payments for promoting medications to other physicians. Furthermore, 95% of respondents noted that their physicians had not disclosed any PhRMA payments, and 70% thought that physicians should disclose that information (a legal requirement coming soon thanks to the Physician Payments Sunshine Act provisions included in the Patient Protection and Affordable Care Act). Finally, the survey shows that a majority (51%) of respondents felt that payments as low as $500 could influence a physician’s judgment.
As professionals, physicians are held to high standards. These include the obligation to ensure that our recommendations for treatment are free of bias and in each patient’s best interest. Research indicates that PhRMA and industry contacts introduce bias into physicians’ decisions that may not benefit patients, leading one to wonder whether any level of PhRMA or other industry contact is ethical.
Physicians’ decisions to work with or take money from PhRMA is largely unregulated (except by voluntarily codes of conduct) and largely outside the public’s view. In theory, physicians can continue taking PhRMA payments as long as we like. However, we should hold ourselves to a higher standard. We know our patients do.