A provision of President Obama’s health care law will mandate public reports on any incidents in which physicians accept speaking fees, five-star meals, or other compensation from pharmaceutical or medical device companies. The new requirement will publish on the internet the names of doctors and the value of the gifts they accept, starting September 30, 2013.
According to Thomas Stossel, MD, American Cancer Society professor of medicine at Harvard Medical School, the new policy is based on the Physician Payments Sunshine Act, a piece of legislation originally introduced by Senators Herb Kohl (D-WI) and Charles Grassley (R-IA) in 2007.
“The ‘Sunshine Act’ is the third federal response attesting to the success of a small group of anti-industry activists over two decades alleging that ‘commercialism’ corrupts medical research, medical education, and medical practice,” Stossel said. “The code word for corruption is ‘conflict of interest.’ The movement’s claims—that industry payments to physicians and researchers result in inappropriate, overly expensive, and even harmful treatment of patients—are inherently unethical and alarm the public.”
Stossel said the first two government responses required “conflict of interest” disclosures by federal research grantees and mandated a total ban on paid consulting by researchers working at the intramural program of the National Institutes of Health.
Concern for Transparency
Allan Coukell, director of the Pew Prescription Project and a clinical pharmacist in oncology, disagrees. He maintains the new requirement will eliminate conflicts of interest.
“We are pleased that Congress has acted on the recommendations of the Institute of Medicine and other respected medical organizations to bring increased transparency to the financial relationships between physicians and the pharmaceutical and medical device industries, which have a vested financial interest in influencing prescribing,” said Coukell.
Robert A. Harrington, MD, professor of medicine and director of the Duke Clinical Research Institute at Duke University, agreed.
“I fully favor collaborative relationships between academics and industry in research and education. But since the interests of each group are by necessity different, there needs to be rules for appropriate engagement,” Harrington said. “Full disclosure of the financial relationships between the groups allows interested parties to understand any real or perceived biases.”
Jerome Kassirer, MD, a professor at Tufts University School of Medicine, said the law will enable the public to judge make its own judgments about these associations. He acknowledges doctors could experience some ramifications.
“The public will be able to go online and determine which of their doctors have been in the employ of industries, and thus which doctors’ opinions they might question,” Kassirer said.
Stossel predicts this will result in overblown reports.
“Unfortunately, activists and media people will collude with politicians to subpoena the institutional records and make a big deal out of almost inevitable discrepancies,” Stossel said.
Coukell says the requirements have been embraced by medical, industry, and consumer groups alike, including major pharmaceutical and medical device trade associations.
“These new requirements provide increased transparency without limiting conduct, and are similar to voluntary steps that a number of companies have already taken,” Coukell said. “A doctor choosing between prescribing drug A and drug B has a conflict of interest if he is being paid by the maker of drug A. Some financial ties—such as gifts—are unnecessary, do not contribute to patient care, and are easily eliminated. Other relationships—such as research—are necessary and beneficial, but greater transparency serves patients and the public good.”
Although reporting will be by company, with no requirements for individual physicians to be identified, Stossel maintains the provision will create a stifling climate for small companies, which cannot afford the compliance costs.
“The failure of physicians and academics who partner successfully with industry to articulate opposition to the allegations has enabled a perfect storm of the activists, ambitious politicians, sensation-seeking media, and politically correct health administrators to inflict onerous regulations limiting freedom of speech, association, and reward,” said Stossel.
“While benign at face value, the call for ‘transparency’ is the driver underlying regulation. The emerging confessional apparatus will incur confusion and costs and will impair physician and researcher collaboration,” he added.
Tabassum Rahmani ([email protected]) writes from Dublin, California.