Tuesday, January 17, 2012

Here's Hoping that Reporting a Practice Will Lead to its Demise

Recently, as a result of news accounts of expensive business trips underwritten by a corporation's not-for-profit foundation, I wrote suggesting that "gimmes" were a bad idea in whatever industry you mention. We all like to think that we're not influenced by "trinkets" ... and the research suggests that we're all wrong.

In today's New York Times, reporter Robert Pear writes that
To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.
What you're hearing now is the sound of me, applauding.

Apparently, if a company has even one product that is covered by Medicare or Medicaid, it would have to disclose all payments made to doctors who are not its own employees. However, it's not clear to me how "payments" is defined.

After all, Pear reports that approximately one in four doctors receive cash gifts from device or drug makers, and that those payments can add up to the hundreds of thousands and even millions of dollars.

Moreover, an estimated two-thirds of doctors accept gifts of food, ranging from a bagel-and-schmear breakfast for the staff, at which at pharmaceutical representative makes a presentation, to an elegant dinner for the doctor. And what about all the pens and clipboards and notepads that we see when we go to the doctor's office, nearly always emblazoned with the logo of some unpronounceable drug?

If you think I'm concerned about something so small as a gimme pen, you're right. Pear writes,
The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.
Pear quotes a pharmacist and consumer advocate at the Pew Charitable Trusts:
Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.
Speaking as a patient, "Yes we do (want to know) and Yes we are (uncomfortable asking)."

My hope is that the payment-disclosure requirement will lead to the complete demise of the gimmes practice. If it happened tomorrow, it wouldn't be too soon.

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