What Pharma Wants to Hide

Patients deserve to know. (ISTOCKPHOTO)

Pharmaceutical companies shouldn't be exempt from disclosing a key payment to doctors.

Congress is now getting ready to pass the so-called 21st Century Cures Act. The draft bill, proposed bythe House Committee on Energy and Commerce, aims to foster medical innovation by streamlining the Food and Drug Administration's regulatory process and increasing National Institutes of Health research funding by $10 billion dollars. The draft, which has overwhelming bipartisan support, leads to many positive implications for patients, medical researchers and pharmaceutical companies. 
However, the bill includes a passage which aims to amend a provision of the Physician Payments Sunshine Act, a law that requires drug companies to disclose their payments to individual physicians and teaching hospitals. The amendment would exempt pharmaceutical companies from reporting a major part of such payments that are made for continuing medical education or CME programs. The supporters of this change argue that physicians get to know about the latest developments in medical science through these programs, and requiring pharmaceutical companies to disclose such payments would discourage them from supporting the programs and ultimately inhibit medical innovation among doctors. 

If we look at the data on these financial transactions, however, we get a much different picture. In the last five months of 2013, physicians who served as faculty or speakers on accredited and non-accredited continuing medical education programs were paid more than $11 million dollars. The payments constitute 2.08 percent of the total financial transactions between pharma and individual physicians. Exempting the pharmaceutical companies from reporting a part of their financial relationship with physicians will not help to foster medical education; rather, it increases the current suspicions about the unjustified impact of such payments on the prescription behavior of physicians.

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CENTERS FOR MEDICARE AND MEDICAID SERVICES/NIAM YARAGHI

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If these medical education programs legitimately increase the awareness of physicians about the latest medical innovations and provide them with unbiased information about the new drugs, then both pharmaceutical companies and those physicians who serve as speakers and on the faculty of such programs should be extremely proud of their role as champions of innovation and envoys of the latest knowledge in the medical community. If that is the case, one would wonder why they wouldn't embrace and support the efforts that shed light on their noble role.

Patients rely heavily on the recommendations of their doctors to make any kind of decision regarding their health and have the right to be informed about their physicians' possible conflicts of interests. Congress should refrain from amending the sunshine act and avoid jeopardizing patients' right to access this information. 

Niam Yaraghi 

Is Your Doctor Being Paid By Pharma? That Could Be Good

John LaMattina

Contributor

Most have heard about how the biopharmaceutical industry pays billions of dollars a year to doctors across the U.S. These payments have been largely undisclosed and this has led many to believe that these funds are being used for the sole purpose of influencing the prescribing practices of doctors. As of September 30th, however, this has all changed. That is because a provision of the Affordable Care Act of 2010, called the “Sunshine Act”, has now gone into effect. This law mandates that not just industry payments to doctors, but also dentists, chiropractors, podiatrists, and optometrists be disclosed. The types of payments include promotional speaking fees, meals, consulting, and research.

These payments can now be viewed by anyone on the Centers for Medicare and Medicaid Services (CMS) website: cms.gov/openpayments. But even before the website went live, debate had begun around the impact and revelations that would be had from the data. Typical was the comment from Allan Coukell, director of the Pew Prescription Project.

“The financial relationships between doctors and drug companies and medical-device companies are a source of conflicts of interest. They have the potential to influence the care that patients get and so they’re a matter of interest both to individual consumers and to policy makers”

The worry, of course, is that any form of interaction between companies and physicians “taints” the judgment of those prescribing medicines to an uninformed public. My guess is that people will be taken aback by the amount of money being paid to physicians. The Wall Street Journal reported that drug and medical-device companies paid at least $3.5 billion to U.S. physicians in just the final five months of 2013. Many will surely think that this amount of money is certainly being used to buy a lot of influence.

However, if one digs into the numbers just a little bit deeper, a different picture emerges. Companies like Pfizer PFE +0.16%, Lilly, and GlaxoSmithKlinehave been disclosing their payments to physicians on their websites for a number of years. Investigating these websites reveals that the vast bulk of these payments are being made to compensate doctors and institutions for carrying out clinical trials. In fact, Pfizer indicates that 80% of its payments to healthcare professionals in the U.S. were for such reasons. Most people don’t realize that the large and expensive trials required to demonstrate the safety and efficacy of experimental medicines are not done by pharmaceutical companies but instead are carried out in academic medical centers by physicians across the globe. These studies are arduous and highly regulated. They require long hours and detailed record keeping that must pass FDA scrutiny. This is difficult work but it is crucial in bringing new medicines to patients. Physicians and their institutions rightfully deserve to be compensated for these efforts.

The biopharmaceutical industry seeks out the best doctors to work with on these important clinical programs. After all, these trials can cost anywhere from $10 – 500 million and one can’t afford suboptimal trial design or execution. Thus, a company tries to involve the best experts for the particular disease for which the experimental medicine is intended. This serves multiple purposes. For one thing, these experts serve not only to lead the trial but also to consult on its design. Furthermore, if the trial is successful, presumably these world experts will have first-hand experience that they will then share by means of publications and presentations.

So, if you decide to go on cms.gov/openpayments and find that your doctors are being paid by the biopharmaceutical industry, don’t automatically assume that they have a tainted relationship with the industry. They may instead be leaders in their fields who are looking to find the next big breakthrough to treat cancer, depression, or heart disease.