Casting more light on doctors’ financial ties may be delayed

    A rule in the federal Affordable Care Act could shine light on the financial relationships that doctors share with drug companies and medical device makers. People from across the biopharmaceutical industry are converging on Philadelphia this month for a Drug Information Association meeting — and plans for the Physician Payments Sunshine Act provision are on the agenda.

    The law was designed to create a website to disclose any payment of $10 or more that drug and device makers give to doctors or research hospitals.

    Psychiatrist Daniel Carlat says patients would benefit from a national database to look up doctors.

    “They really want their doctors to practice medicine based on the evidence rather than based on a marketing visit from a drug rep or a pharmaceutical company,” he said.

    Carlat leads a group at the Pew Charitable Trusts working to reduce conflicts of interest that hurt health care. He said information from within the pharmaceutical industry shows that treatment decisions can be influenced.

    “When pharmaceutical companies have doctors sit in on lectures with either pharmaceutical reps or other doctors, they keep track of how those interactions affect prescribing,” Carlat said.

    Dr. Thomas Stossel, a hematologist at Brigham & Women’s Hospital, says he hasn’t seen that evidence.

    “There’s this whole, enormous urban legend that doctors uncontrollably prescribe certain products because they have relationships with pharmaceutical companies or device companies — it’s unproven,” he said.

    Stossel, who tracks policy issues around physician-industry relationships, said a disclosure database would most benefit “predatory litigators” looking to make money from drug companies that break the rules.

    In Philadelphia, Wharton School professor Robert Burns said increased transparency may weed out “sham relationships,” if it’s used.

    “I do think the patients do benefit from knowing this, but I don’t think most patients will go to the Web to find out if their doctor has a relationship,” Burns said. “I think that the only people that are going to use it are the people like me that study the relationships.”

    Burns said collaboration between pioneering doctors and developers is critical to medical device innovation.

    Separately, Carlat argued that the disclosure database could increase the trust patients have in their doctors, when they see that a physician receives money for “important research” that advances medicine.

    Policy watchers say with continued controversy — and questions — the “sunshine” law implementation may be delayed until 2013.

    A new Archives of Internal Medicine study from the University of Colorado and Harvard University suggests that gift and payment disclosures have little effect on the medicine brands doctors prescribe. The research is based on comparisons of states where payment disclosure are already required and states where the disclosures are not required.





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