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Shining a Needed Light on PhRMA/Physician Interactions

Posted by Mark Ryan, MD January 22, 2012 at 10:26 PM

Recently, National Public Radio’s program “On the Media” discussed the Physician Payment Sunshine ActThis legislation (PDF; a useful overview is available here–also a PDF) was part of the Patient Protection and Affordable Care at and requires that pharmaceutical companies (PhRMA) disclose how much they pay physicians in compensation for being consultants, on speaker’s bureaus, etc.  The rules that were released in December 2011 go even further than many expected: PhRMA and medical device makers will need to disclose how much they pay physicians for speaking at formal CME events.

There are many physicians who will claim that these talks are educational–whether at CME, or at industry-sponsored events.  They will also claim that they only speak on behalf of medications and/or companies they believe in.  However, ProPublica’s excellent Dollars for Docs investigative series has detailed ways in which PhRMA and other industry actively seek to control physician’s presentations and often target the speaking physician as much as their audience.  However, there are rising concerns that these relationships might not only raise costs, but could lead to harm or promote care that might not be in patients’ best interests.

If physicians and industry are proud of these relationships, then they should be wiling to open their books for patients’ review.  If we are receiving medical advice and care from professionals, we should be able to know if their interests might be skewed based on their relationships with industry.  The Sunshine Act will help accomplish this: patients will be able to review who pays their physicians, and can make their own decisions as to whether this has any impact on care.  In return, putting this information out in the open will encourage physicians to be transparent and encourage us to provide evidence-based care that is patient-centered.

Until the Sunshine Act’s database is available online, I recommend using ProPublica’s searchable database to see if your physicians are getting paid by PhRMA and medical device manufacturers.  What you find might be revealing…and your physician’s response if you ask them about payments might be surprising.  I readily admit that not all these connections are necessarily bad…but in that case there should be even less need to hide them.

NPA has a strong position about conflicts of interest in medicine, which led to our Unbranded Doctor campaign.  Patients deserve unbiased medical care, and physicians should be held to that standard.  We are willing to do our part.

Join us.

Update – February 2012

NPA’s Public Comments regarding Implementation of the Sunshine Act Provisions of the Affordable Care Act, submitted to CMS 2/17/2012

3 Responses to “Shining a Needed Light on PhRMA/Physician Interactions”

  1. Lindsay McNair, MD, MPH says:

    PhRMA is not an abbreviation for “pharmaceutical companies”, it is a membership organization. Referring to all pharma companies as PhRMA is like referring to all physicians as AMA.
    ” …then they should be wiling to open their books for patients’ review.” Great. The implication here is that they are not willing, but where is the evidence of that? Many pharma companies have had online databases with this information for years, as have academic centers.
    “..control physician’s presentations…” Of course they do, if the pharma company is sponsoring the presentation. If the doc starts talking about unapproved use, or citing inaccurate safety data or efficacy numbers, the company is now liable for off-label promotion or inaccurate information. They have to have some control over what is said.

    Dialog about this is great. But let’s not start from the perspective that everything pharma does is evil, just because they’re pharma, because that doesn’t get anywhere.

  2. Mark Ryan, MD says:

    Dr. McNair;

    Thanks for the comment. A few thoughts:

    –I admit PhRMA is a lazy shorthand. But considering the numbers of major pharmaceutical companies that PhRMA represents (http://www.phrma.org/about/member-companies) it’s clear that the major players are part of PhRMA. So I don’t feel this is the same as calling all doctors “AMA”, when the AMA counts around 25% of US practicing physicians as members at this time. Very different.

    –The Sunshine Act requires companies to make the info public. Just because the information has existed doesn’t mean that it will be easily found…the law will address that. ProPublica has done the best job that I have seen in collating all this information. The Sunshine act should allow this info to be more broadly available. If you have pharmaceutical companies that are available and easily accessible, I would be happy for you to share them here.

    –I don’t think everything pharmaceutical companies do is evil…but I think they’re claims of being white knights bears scrutiny. The $ they spend encouraging physicians to use medications with questionable indications (http://well.blogs.nytimes.com/2012/01/26/using-symptom-checklists-to-sell-drugs/?ref=health), the $ spent on me-too drugs (Nexium, Clarinex, etc) that offer minimal improvement over generic options: these practices should be part of the dialogue.

  3. Mark Ryan, MD says:

    Another thought, related to your final point: pharmaceutical companies control the presentations doctors give…and the doctors themselves might not be aware:

    http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?pagewanted=all

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