An Ethical Checkup for Doctors

Most doctors make sure they have their own medical checkups. But do they also make sure that they have an ethical checkup?

When your doctors recommend you take certain medications or strongly suggest you have a procedure that includes a medical device, you usually take their advice. Right?

Would you be as likely to follow their guidance if you knew that they were receiving payments, sometimes thousands of dollars, from the companies that manufacture those very drugs or devices?

Each year, drug and medical device companies pay millions of dollars to doctors who advise patients to taking their drugs or use their medical devices. Physicians who prescribe such drugs are under no legal duty to inform their patients that they have received payments or gifts from the same companies.

This nondisclosure flies in the face of two of the bedrocks of ethical behavior: avoid conflicts of interest, and if a conflict exists, advise those affected so they can make informed decisions.

ProPublica, one of the best investigative news organizations in the country, identified more than $2 billion (that’s with a B) in payments made to doctors by 15 drug companies for promotional speeches, research, consulting, travel, meals, and related expenses from 2009 to 2012. (See projects.propublica.org/docdollars/.) This information has become available primarily because of legal settlements with the drug companies. In California alone, doctors have received in the range of $298 million over the last four years.

The individual top moneymaker, according to a ProPublica report, did not come from California. Tennessee psychiatrist and addiction specialist Dr. Jon W. Draud earned more than $1 million for delivering promotional talks and consulting for seven drug companies. ProPublica reports 21 other doctors have made more than $500,000 since 2009 by giving speeches and consulting for drug companies. Many of these top earners come from one medical specialty: psychiatry.

Tracy Weber and Charles Ornstein, the principal ProPublica investigators and writers on the topic, summed up the argument that drug companies use to justify paying doctors to speak to other doctors about drugs and medical practices: “The companies say physician speakers are the best messengers to teach their peers about new and effective treatments.”

Weber and Ornstein then noted what many critics have said about such payments: “ … the speakers are little more than highly credentialed pitchmen who typically use the drug companies’ slides and talking points to sell rather than educate.”

Besides doctors who receive money for teaching, those who receive gifts and have dealings with drug companies “tend to prescribe differently,” said Daniel Carlat, director of the prescription project at the nonprofit group Pew Charitable Trusts. In a BBC News report, he went to say:

“ … They prescribe more drugs, more expensive drugs, more brand-name drugs, and they’re less likely to follow evidence-based practice guidelines in prescribing drugs. To the extent that all of those relationships lead to inappropriate prescribing … that could be a massive problem in terms of health-care costs and also in terms of public health.”

You can find out if your physician, for whatever reason, takes money or receives gifts from drug companies. The ProPublica user-friendly website allows searchers to enter the name of their doctor(s) and the state where the doctor practices to find whether the physician has received payments from drug companies. The site provides the name of the drug company, the amount paid to the doctors, the year it was paid, and whether it was for research, consulting, travel or other.

In fairness, ProPublica makes it clear that a doctor receiving money from a drug company does not automatically mean the doctor has a conflict of interest. The purpose for which the doctor received the drug company funds may have no correlation to how the doctor conducts his practice.

Even if the doctors are just teaching, I still think it still raises the appearance of conflict of interest. One doctor wrote me, “I don’t have any such financial relationship … because I think such relationships would compromise the legitimacy of my scientific/academic endeavors.”

The practice of paying doctors to give speeches and attend conferences may well be changing. The Physician’s Payments Sunshine Act, part of the Affordable Care Act, which goes into effect in fall 2014, will require all drug and medical-device companies to comply with laws that make it mandatory to disclose financial relationship the companies have with doctors and teaching hospitals.

Finally, as more online websites publish the data that the Sunshine Act requires, university and teaching hospitals may tighten their rules on drug company payments.

In December 2013, British drug giant GlaxoSmithKline announced that it will no longer pay doctors to promote its products. The company will take three years to completely stop the practice of paying professionals to speak about its products or the diseases they treat “to audiences who can prescribe or influence prescribing,” reported the New York Times.

All good news? Sure. But the problem still remains that even though the Affordable Care Act will make information about drug company payments to doctors available, doctors will not be required to disclose this information to their own patients.

This loophole must be plugged.

Just as doctors put up signs in their waiting rooms about their patient payment policies, it should be mandatory for doctors to provide written information to all patients about payments the doctors have received from drug and other medical companies.

I hope that medical consumers, aka patients, will soon be able to ask their doctors a version of the TV credit-card pitchman query: “What’s in your wallet, doctor, and where did it come from?”