Saturday, April 12, 2008

Sea Change? Companies Offer to Disclose Gifts, Grants

Sen. Charles Grassley of Iowa, who despite his Republican credentials has become one of the major Congressional thorns in the side of Pharma, recently sent out a query to 15 drug and device companies. He asked--what plans do you have to disclose the grants that you now provide for support of continuing medical education (CME) programs (following the lead of Eli Lilly which voluntarily began such disclosures)? And if you don't plan to disclose, why?

Since Sens. Grassley and Herb Kohl (D-WI) have introduced legislation to require companies to disclose any payments to docs of any value, the industry apparently took this recent query from Sen. Grassley as the proverbial offer they could not refuse. All except Schering-Plough said that they would do something, or would at least support in principle, the disclosure of these data.

Industry critics (like Dr. Peter Lurie of Public Citizen) immediately labeled these statements an obvious ploy to avoid the heavy hand of legislation. Which makes sense. But whatever the outcome, I would classify this recent set of developments as a sea change in national Pharma policy. The industry which in the past could pretty much always get its own way in Congress as soon as it unleashed its army of lobbyists, now seems much more on the defensive.

Still, let's not break out the champagne just yet. What would have to happen for this disclosure to be adequate and comprehensive? It's noteworthy that the company responses went significantly beyond CME in some cases, as companies promised to disclose also their grants to medical organizations and to patient advocacy groups.

When I was doing the research for HOOKED, I worked by myself and also in company with two economist colleagues to get accurate data on the total amount of industry expenditures in many categories that impacted medical practice and the health system. The three areas where we had the hardest time assembling accurate figures were:
  • Total industry gifts (i.e., bribes) to physicians
  • Industry contributions and payments to medical professional societies
  • Total revenues of medical journals and industry income as a percentage of that
So, in relatively short order, two out of these three categories promise to become much more transparent than in the past.

If the industry plans to come clean, the companies will show their good will by revealing both the total amount spent on all these gifts and grants, and also the total, actual budget for marketing drugs. We continue to have two or more sets of books being kept on what the industry spends on these items. The "official" figures from firms like IMS health for the US drug industry is about $29B annually; Marcia Angell, in her book The Truth About the Drug Companies, claimed based on careful examination of SEC filings and on other sources that the real figures was more like $45B; and as I recently blogged (1/4/08), Gagnon and Lexchin recently did some new calculations that came out about $57B. Only the companies can resolve these discrepancies, if they would.

An incidental revelation in one story about these events recalls that the recent Senate Aging Committee hearings on excesses in the device industry included mention of meetings of paid company consultants at resort locations. The docs attending had all travel expenses paid, attended a few hours of meetings per day with the rest of the time free for leisure; and gave presentations for as little as 10 minutes--and for that were paid $5000 per day as consultants. So tell me again how these consultants are essential cogs in the machine of discovery and innovation.

Freking K. Drug companies to reveal grant practices. San Francisco Chronicle, April 11, 2008,
Associated Press. Drug companies may reveal donations. Boston Globe, April 11, 2008,

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