Auld Lang Sunshyne
With the change of the calendar year, Big Pharma has rolled out its New Year’s resolutions like the rest of us, most prominently the revised PhRMA voluntary code of conduct, which aims to stop the trinketeering, lavish meals, and travel payments to prescribers. The code changes, combined with pledges by some drug companies last year to disclose payments to physicians have got some observers (including reporters) saying that maybe the industry has turned a new leaf.
Maybe. But let’s look at what the companies have really said:
In September 2008, Eli Lilly, which already discloses its educational and charitable grants on its website, said it would begin to publicly report all speaker and advisory payments by the last half of 2009, and in 2011 would make public all payments to docs over $500 (including meals, entertainment, and travel).
That same month, Merck announced it will report all speaker payments in 2009. No sign of that yet (according to our very recent internet search).
In October, GlaxoSmithKline, under fire from a Senate investigation into Dr. Charles Nemeroff’s busy and lucrative speaking schedule, announced it would disclose payments to doctors and cap payments per doctor at $150,000 a year (nice work if you can get it), but has not given anymore specifics, like where, or when, or what kind of payments.
The Project praised these commitments at the time, and we’re still happy to see companies taking (or planning) steps toward great transparency. But let’s remember that information transparency only as good as the accessibility of that information– meaning, can people get to it, and understand it once they do?
We think that each drug company disclosing the payments it wants, starting when it wants, in a format of its own choosing is a bad deal for patients – who are the reason transparency is so important. The unbiased clinical decisions clouded or threatened by these corporate relationships are, after all, decisions about them, and their health.
Patients should not have to go to seventeen different websites to see whether their doctors are taking funds from drug companies, which is why a single, uniform and publicly accessible database like the one proposed in the Physician Payments Sunshine Act makes so much sense.
January 11th, 2009 at 10:51 pm
[...] out that the biotech drug industry refuses to even adopt the voluntary PhRMA code (and see this Prescription Project blog post comparing words and reality, so [...]
January 12th, 2009 at 2:48 pm
The NEJM had a wonderful summary by two physicians who reviewed discovery documents in a court case outlining the efforts the drug companies will go to influence its prescribers. What came across as more surprising is the lack of restraint on the part of the academic leaders in influencing those of us dependent on their advanced expertise.
As a college student in the pre-computer days there were ads for companies willing to write your term paper. A C+ guaranteed or your money back. Now there are people who will attach your name to their research work and have them pay you for doing your term paper.
There are a couple of suggestions I might make as an office practioner who will occasionally go to a nice dinner to hear and question a true expert whose mind and experience I would not ordinarily be able to access. First, if the companies want to pay ten experts a million dollars each, let them. That is not where the abuse comes from. It derives from inviting every local yokel specialist affiliated with the largest local medical facility who has never done a lick of the research of what he speaks to convey the company’s opinion. Real experts yes, pseudoexperts no. Second, the costs of drugs would be less in aggregate and the utilization more thoughtful if the company representatives could walk through the physicians’ doors by invitation only. One of the tragedies of Neurontin, the NEJM subject, and a lot of other drugs is that they are decent substances for the purpose they were developed and tested. Expansion of markets beyond the approved niche does not require that same level of testing and disclosure, only a testimonial from a local respected practitioner that he or she likes to use the drug for another purpose and in his or her opinion those who withold it when the circumstance arises shortchange their patients.
rich the furrydoc