Should Drug Companies Reveal Payments to Doctors?

Drugmaker Eli Lilly announced this week that it would begin publicly reporting all payments it makes to doctors for speaking and consulting services. The Indianapolis-based company already reports grants to hospitals and for-profit medical education companies, and other big pharmaceutical companies have said they're working to set up similar plans. Meanwhile, a bill to require companies to report their payments is working its way through Congress. NEWSWEEK's Tina Peng spoke to Eric Campbell, an associate professor at Harvard Medical School and the Institute for Health Policy who studies the relationship between academia and the drug industry, about why it's important for industry-doctor relationships to become more transparent. Excerpts:

NEWSWEEK: Pharmaceutical companies fund drug trials and pay doctors to sit on industry panels. Are there other ways they interact with medical professionals?
Eric Campbell: There a number of ways in which doctors can interact with drug companies. They range from things such as giving lunches, hosting and providing educational opportunities for doctors, taking doctors and their staff out for dinners at fancy restaurants, to things such as trips to conferences and even, in the past, vacations and so on. They can also provide physicians who conduct research with research funding, assistance to recruit patients and so on.

But with federal funding for research continuing to tighten and drug trials, it kind of seems that the money might be necessary. Do many doctors think twice before accepting industry funding?
On the research side, I think much of the research, the important research that's conducted, wouldn't happen if it were not for drug-company support, simply because it's research that the federal government doesn't fund. I don't know the data on how frequently doctors think twice [about whether to take the research funding], but I've had numerous doctors over the years call me on the phone to discuss their thinking. Those conversations generally focus on the perception, rightly or wrongly, that taking money from a drug company somewhat tarnishes the object of their research. There is research out there showing that the results of [industry-funded] studies are significantly more likely to favor that company's goods and services. So there is some reality to the perception that drug-company funding is in some way associated with pro-industry results.

What are the dangers of having other medical professionals receiving private funding? Are there many cases where doctors will advocate for drugs that aren't necessary or efficacious?
[Industry-doctor] relationships form hidden explicit or implicit inducements for physicians to offer companies products and services. They're hidden from patients, they're hidden from people who run hospitals, from people who purchase health care, and they're even hidden from things like Medicare. They create an inducement—in some instances, these inducements may cause physicians, even unknowingly, to prescribe company products that may not be in their patients' best interests.

If a doctor provides a patient the newest brand-name drug from a company because he has a relationship with that company rep, but a generic would do just as well, that's not the best for the patient. If a patient is on a drug that he or she is doing very well on, and all of a sudden the doctor switches the patient to another drug because he has a visit from the drug rep, that's not in the patient's best interest. There are some things that I think it's very hard to think about how they benefit patients. How does it benefit a patient if a drug rep brings a doctor's nurses and staff lunch two or three times a week? If a drug rep takes a doctor out for a golfing match, how does that benefit patients? Sometimes these things can benefit patients. I had a colleague who was telling me that he went to a drug-sponsored lunch, learned about a drug he didn't know about, used it and had some patients benefit right away. But what we need to know are to what extent do these things help patients, to what extent they harm patients, and what are the financial implications of these things for health care in America?

Are there oversight mechanisms for institutions to regulate how their doctors interact with pharmaceutical companies?
It's getting better, but in recent years, most medical schools and teaching hospitals had mechanisms to monitor the relationships of their researchers but not necessarily faculty who were on staff but only providing clinical services. I think institutions are moving much more quickly to get those mechanisms in place. But that's just a beginning—you can't regulate what you don't know about. I know one major medical school, which, up until a year ago, had no idea what relationships their clinical faculty had with companies until it showed up on the front page of the local paper in a major scandal. Institutions, by and large, have done very little, if anything, in terms of oversight in these relationships. Many medical schools and teaching hospitals have begun to put the clamps hard on certain relationships. Many have banned drug reps from roaming the halls, many have banned industry lunches. But in a few places it's just moved across campus, so instead of being held at the hospital it's being held at the hotel across the street, and they have the noon white-coat parade where all the doctors go across the street to get their free lunch from the drug reps.

Will more companies move in the direction Eli Lilly has taken? Do you think industry-doctor relationships are going to become more transparent, and will this come from both sides?
I haven't seen Eli Lilly's full proposal, so I don't know for sure. There are a couple of rationales for why this is happening; one could argue that hospitals, states and federal government are moving at breakneck speed toward having publicly available data on this. They may just see the writing on the wall and try to get ahead. Others have argued that [transparency] is a way to stem off legislation: "Oh, we're doing it ourselves, there's no need to regulate us." But there's no way to know that what's being told is true, if everything is being told. I applaud Lilly for getting ahead of this, but in the end it may just be that they see the writing on the wall. What's coming—if it doesn't come on the federal front, it'll come on the state front, and if it doesn't come on the state front it'll come on the institutional front. I think the bottom line is, the marketing model of giving doctors stuff to get them to prescribe is over. That doesn't exist anymore because institutions are going to stop it. [Drug companies] are going to have to do something else to get access to doctors to try and move their products.

How should it work?
I'm not against interactions between doctors and drug companies. I think interactions between them can be good. What I am against is the providing of inducements for those interactions. Don't take them up on lunch, don't meet them at a fancy restaurant, don't go down to Florida for four days to meet with them. And if you do do those things, pay for them yourself. Don't pass the costs of those things on to the American public in the form of higher drug prices.

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