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Time to bring pharma-physician relationships out of the dark ages?

January 7, 2009
by kate
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Transparency is always a hot topic, and with the economy in poor shape, it could become even hotter.

As organizational
budgets are put under a larger microscope, one area that could really come into focus is the relationship between physicians and pharmaceutical companies. It’s one of those issues that everyone is aware of but isn’t quite sure whether — or even how — to address it. Kind of like the way the Yankees can spend a half billion dollars during a recession.

Penn Medicine, however, is a step ahead of the game. Last month, the $3.5 billion enterprise that owns University of Pennsylvania School of Medicine and the three-hospital, 1,527-bed University of Pennsylvania Health System announced plans to launch a Web site that will provide information about physicians’ financial ties to pharmaceutical and medical device companies. According to an article published in the Philly Inquirer, the move is part of “an emerging trend in response to growing concerns about medical conflicts of interest.”

The organization already had a conflict of interest policy in place banning staff from accepting gifts, meals, and free samples from pharmaceutical companies. But now, it is using IT to bring the issue to light — even further.

Cleveland Clinic is also leveraging technology to address the growing problem. Last month, it also began posting disclosures of physicians’ and researchers’ business relationships and financial ties on its Web site.

While it’s an important first step that individual organizations are taking it upon themselves to deal with potential conflicts of interest, many feel that state or even federal government should step in; that in order to tackle big pharma, help is needed from big government. Senators Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.) are pushing legislation requiring that data on industry payments to physicians of more than $500 be made available in a public national database. And in Vermont, lawmakers are calling for an online database providing residents with information about physician-pharmaceutical industry relationships. It’s designed to be an upgrade of the current system in which the Attorney General’s Office releases a report that some say isn’t user-friendly.

The proposed changes, however, also include eliminating a trade-secret exemption that lets the pharmaceutical industry conceal the amounts of money contributed and the identity of the doctors. While this plan has the support of the Vermont Medical Society and the Vermont Psychiatric Association, it is, not surprisingly, strongly opposed by the Pharmaceutical Research and Manufacturers of America, which plans to fight efforts to remove the trade secrets clause, according to the Barre Montpelier Times Argus.

What I wonder is, does big pharma have a leg to stand on here? I understand the right to privacy, but if a patient’s doctor has a relationship with Pfizer that could possibly influence his/her decision when prescribing a medication, doesn’t the patient have the right to know? What’s more important, privacy or what’s best for the patient? Seems like a theme we’ve heard before.

What are your thoughts on this issue? What do you see happening in the near future?

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Comments

Great Issue.

My office just spent a significant amount of time returning gifts from my "friends" during the holidays. Being employed a public university, our guidelines are pretty stringent for numerous reasons.

The issue is complex however. Medicine is in large part driven by advances in technology (pharmaceuticals and medical devices). You want your doctor to be up to date on the latest advances, but you don't want her to accept money to attend training or even trial new technologies/approaches. Moreover, your doctor might actively want to participate in the development of these technologies (why should she have to disclose how much she is paid?). I don't disclose my salary at UT Southwestern (actually I do through the Freedom of Information Act -!) and we get grants from many sources including Pharma.

I'm inclined to agree with Cleveland Clinic's approach, but as a patient, what am I supposed to do with that information? So my doctor works with Glaxo, am I supposed to compare every prescription he gives me with competitor drugs. I wouldn't know what to do....

Here's my BIG problem. Does the fact that a researcher receives money from a drug company affect the quality/depth/outcome of their research? If so, that affects the entire industry's understanding of the effectiveness of drugs and therapies. I'm no expert on this matter, but it is very troubling. We need better controls and supervision.

The Atlanta Journal-Constitution

Tuesday, December 23, 2008

Emory University on Monday permanently stripped Dr. Charles B. Nemeroff of his department chairmanship and placed severe restrictions on the internationally known psychiatrist's extracurricular activities.

Emory's announcement followed an internal investigation into $800,000 in payments made to Nemeroff by the global pharmaceutical company GlaxoSmithKline between January 2000 and January 2006. Nemeroff received the payments for more than 250 speeches he made to other medical professionals.

Nemeroff has been a central figure in a federal investigation of whether drug company payments to doctors and academics skew research in favor of certain drugs.

In its investigation, Emory found that Nemeroff had violated the university's policies by not reporting his outside income from GlaxoSmithKline. He was Emory's chairman of the department of psychiatry since 1991.

Nemeroff was paid by other drug companies, but the university only reviewed payments from GlaxoSmithKline because it was his largest single payer, and the company cooperated with Emory.

Nemeroff's most powerful critic, U.S. Sen. Charles Grassley (R-Iowa), who is conducting the investigation into National Institutes of Health grants, applauded Emory's actions on Monday, calling them "swift and sure-footed." Emory's psychiatry department received $22 million in NIH grants last year.

In a statement, Grassley said, "Accurate disclosure and transparency are fundamental to the integrity of medical research. Without them, the public trust is violated and public confidence in the system is legitimately shaken."

In addition to losing his chairmanship, Nemeroff will not be able to apply for NIH grants for at least two years and will need pre-approval from the dean of the medical school for any outside income.

In a statement released by Emory, Nemeroff said: "I regret the failure of full disclosure on my part that has led me to the current situation. I believe that I was acting in good faith to comply with the rules as I understood them to be in effect at the time."

Thank you both for your input.

Suresh, I agree completely that this is a very complex issue, and not as black and white as it may seem. Just because a physician accepts money from a certain company, it doesn't mean that he/she will push their products even if it isn't necessarily the best thing for the patient. But when a physician receives $800,000 over 6 years from one company, red flags are going to up.

I'm not sure what exactly the right solution is, but I agree that better controls are needed.

Great post Kate. The relationship between many physicians and pharma reps is dirty business. I guarantee that any regulations, such as limiting gifts to $500, will be skirted. For example, reps will simply split large dinner checks up, water will find a path downhill. Is government intervention the answer? Probably not. Look how well campaign finance reform has gone. This will probably just have to be a "buyer beware" issue. Get to know your doctor, ask the tough questions about "how they got all those free samples" in a delicate way. I think, as usual, the consumer has to take responsibilty for themselves and not rely on the good will of government to protect them.

kate

Kate Huvane, Associate Editor of...