Sunday, December 21, 2014

Soon, more pay and gifts to M.D.s can be seen online

The Dollars for Docs website. This fall, the U.S. government will start a site.
The Dollars for Docs website. This fall, the U.S. government will start a site.
WASHINGTON - When many of us have a medical appointment, we're concerned about our finances: How much will we owe out-of-pocket? What's our co-pay? But next time, you may also want to ask your doctors about their financial situations.

That's because nearly 95 percent of U.S. physicians accept gifts, meals, payments, travel, and other services from companies that make the drugs and medical products they prescribe, according to the New England Journal of Medicine. This has been a common practice for decades, and studies show it affects doctors' prescribing decisions. But for the first time, patients will soon be able draw back the curtain.

Starting in September the federal government will make available an exhaustive online database of payments to U.S. physicians and hospitals, under a section of the health-care overhaul passed in 2010. The measure, known as the Sunshine Act, requires most makers of drugs and medical supplies to report all payments, gifts, and other services worth $10 or more that they provide to health professionals.

"I think every patient out there should know who actually is paying their doctor," says Paul Thacker, a fellow at Harvard University's Safra Center for Ethics. "The one thing we know is that money changes behavior and people tend to respond to who is giving them money."

As a Senate staffer, Thacker helped craft the disclosure rules, which are designed to lay bare the industry practice of "detailing," in which company salespeople court doctors with everything from pens and mugs to lucrative speaking engagements. Pharmaceutical companies spend an estimated $20.4 billion on these activities each year and then track doctors' prescribing patterns to gauge the return on their investment.

Using a federal website, patients will be able to search most payments made to their health-care provider, from $20 lunch bills to hundreds of thousands of dollars in consulting fees. Some of this information has already come to light, mainly due to legal settlements that required drugmakers to disclose the information.

Websites such as Dollars for Docs, from the nonprofit journalism group ProPublica, pool this information together and enable users to search doctors by name to see what payments they have received. The database covers 15 pharmaceutical companies, including Pfizer Inc. and Johnson & Johnson, and begins with payments made in 2009.

But how is a layperson to make sense of it all? And how does one separate common medical practice from truly questionable activity?

Leana Wen, of George Washington University, says she simply groups all payments into two categories: research and everything else.

Most studies on new drugs and devices are funded by companies, which partner with physicians to enroll patients and track their responses to the treatment. Wen and others say these partnerships are a necessary part of clinical research and are common at leading medical centers. But, she says, virtually all other payments are problematic.

"If someone gets significant consulting fees or speaking fees, I would be more concerned about that because they are doing something that has been shown in studies to change their prescribing habits," said Wen, who teaches at the university's emergency medicine department.

An analysis of 29 studies published by the Journal of the American Medical Association in 2000 found that doctors who accept fees, meals, and other perks from drugmakers are more likely to prescribe their brand of drugs. This can negatively affect patients because the medicines promoted by drugmakers are usually newer, more expensive, and potentially less safe than older medicines.

Although patients will benefit from increased transparency in coming years, the ultimate goal of policymakers is to pressure doctors to give up some of their more egregious relationships with industry. It's too early to tell whether those ties will be weakened, but supporters of the Sunshine Act are encouraged by early reactions from their colleagues.

"Some of them are now saying, 'It's just as easy for me to buy my own lunch. I don't need drug company people coming in and doing that,' " said Stephen Smith, professor emeritus at Brown University.

Matthew Perrone Associated Press
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