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Through the looking glass
- Mark H Wilson (13 November 2008)
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Public disclosure of physician payment
- Atif A. Kukaswadia (22 November 2008)
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Mark H Wilson, Director of Medical Ethics Health Research Associates, Ottawa,
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An air of the surreal surrounds the news that a leading drug company is capping US doctor’s honorariums to 150,000 dollars but leaving the amount open for European doctors. The rationale offered to explain the difference is that European doctors are not paid as well as their US counterparts. The press release is framed around good corporate governance in the US in response to concerns about commercial conflict of interest. And it is marketed as corporate benevolence in response to underpaid European doctors. It is difficult to know whether to laugh, cry or throw hands up in frustration over the spin put on the incongruity. The global financial crisis might help explain the situation. An expected recession due to the financial crisis is leading to belt tightening in the corporate sector. Reducing US honorariums to 150,000 dollars might reflect the trend. While it is noted that the amount shows the depth of drug company pockets, it also indicates some belt tightening given the reported amounts of money some US doctors have received from drug companies. Also, corporate patronage and conflict of interest are now major issues and have gained strong public attention due to the impact of the financial crisis. These issues mirror public concerns surrounding drug companies. Questions over a lack of transparency and accountability in a self regulating market economy that has produced a financial crisis are being raised constantly by the media. Nor have concerns abetted in light of a bail out process that has also lacked transparency and accountability to date and revelations that public money has been earmarked by Wall Street for bonuses. (1) Given the impact of the financial crisis and its governance concerns about patronage and conflict of interest, drug companies will likely engage in greater public relations and market their governance image. While reducing US honorariums to 150,000 dollars is hardly loose change and has patronage leverage, it is in keeping with the corporate culture and theater of the absurd that plays on Wall Street. 1. The Guardian, October 18, 2008 Competing interests: None declared |
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Atif A. Kukaswadia, Graduate Student Queen's University, K7L 3N6
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There are two issues to be considered when contemplating the issue of physician compensation by pharmaceutical companies: firstly, which payments should be made public, and secondly, how much physicians should be allowed to receive. A previous issue of the BMJ reported that GlaxoSmithKline is limiting the amounts it pays US physicians (1), but this is a small step in encouraging complete transparency between physicians and the public they treat. Other companies have already begun this process, such as Eli Lilly and Company, a US-based pharmaceutical firm, who will launch an online database of physicians under their payroll accessible to the public as soon as the second half of 2009(2), and other companies should follow suit. The US Physician Payment Sunshine Act (introduced as S.R. 2029, currently H.R. 5605 (3)), if passed, will make this mandatory for all companies. This legislation already exists in certain states, such as Vermont, who require that pharmaceutical companies report all physician payments, including travel payments, grants, food and honoraria(4). There is leeway however, as this legislation allows for companies to not report payments if they are considered “trade secrets” (4). Ross and colleagues found that “trade secrets” encompasses many different definitions and varies significantly; GlaxoSmithKline reported all of their payments as trade secrets in this study, while overall, 61% of payments made to physicians in Vermont were classified as trade secrets(4). Even then, companies were not required to show which doctors received remuneration, and 75% of publicly disclosed payments lacked any identifying information, simply referring to the recipient as “doctor,” “nurse” or “health care professional.” These efforts to force disclosure are important and need to be monitored for their consequences on prescribing patterns. The size of the gift has been shown to not matter, and simply receiving a gift from a drug company can impact a physician’s perception of the company and their tendency to prescribe certain drugs as a result (5). These disclosure loopholes need to be closed or standardized to protect the public and ensure complete transparency. Citations 1. Kmietowicz Z. GlaxoSmithKline to limit payments it makes to US doctors to $150,000 a year. BMJ. 2008 Oct 30;337:a2315. 2. Lilly set to become first pharmaceutical research company to disclose physician payments [homepage on the Internet]. Indianapolis: Eli Lilly and Company. 2008. Available from: http://newsroom.lilly.com/releasedetail.cfm?ReleaseID=336444. 3. H.R. 5605-110th congress (2008): Physician payments sunshine act of 2008 [homepage on the Internet]. GovTrack.us. 2008. Available from: http://www.govtrack.us/congress/bill.xpd?bill=h110-5605&tab=analysis. 4. Ross JS, Nazem AG, Lurie P, Lackner JE, Krumholz HM. Updated estimates of pharmaceutical company payments to physicians in Vermont. JAMA. 2008 Nov 5;300(17):1998-2000. 5. Blumenthal D. Doctors and drug companies. N Engl J Med. 2004 Oct 28;351(18):1885-90. Competing interests: None declared |
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