Monday, March 22, 2010

Along for the Reform Ride: Sunshine Legislation

We have focused much less lately on the Physician Payment Sunshine Act, in part because the legislation had become bundled into the larger Senate health reform bill and hence awaited the fate of that legislation. So it was easy to forget last night that Sunshine was along for the ride when the House passed the Senate version of health reform. Thanks to our friends at the Pew Prescription Project for this announcement:


WASHINGTON – Allan Coukell, director of the Pew Prescription Project, issued the following statement today, commending Congress for including provisions from the Physician Payments Sunshine Act in health care reform legislation. The provisions would require drug and device companies to publicly report the gifts and payments they make to doctors.

“Patients deserve to know if their doctors are receiving money from drug companies. Congress has added much needed transparency to the financial relationships between the pharmaceutical industry and physicians. The reporting requirements in the health care legislation will better protect patients and will help restore trust in our health care system.

“A study in the New England Journal of Medicine reported that more than 90 percent of physicians have some financial relationship with the pharmaceutical industry. We also know that companies spend at least $25 billion each year marketing to doctors. While many relationships between academic medicine and industry are necessary and beneficial, they create potential conflicts of interest that can influence prescribing and drive up costs.

“This new legislation will enhance the safety of consumers by increasing transparency while in no way restricting business or limiting innovation.”


Michael Kirsch, M.D. said...

You enthusiastically, and understandably, endorse the Sunshine proposal where physicians would disclose financial relationships with industry. Do you think it would be better if these potential conflicts were banned outright, so physicians would have no potential conflicts? do you feel that disclosure alone is sufficient?

Howard Brody said...

Quite right, Michael. I am under no delusions that mere disclosure is sufficient. As I explain in some detail in HOOKED, disclosure is part of the Management Strategy, which tolerates conflicts of interest and assumes that we can manage them satisfactorily. I advocate, for the most part, the Divestment Strategy that tries to eliminate the conflicts. Wags have commented that if I am cheating on my wife, then my disclosure of the affair hardly counts as moral justification for continuing it.
The Physicians Payment Sunshine Act is a means, potentially, toward the end of Divestment. If physicians' names are disclosed in public, then at least some will decide not to take the Pharma money. Many more (sadly) will continue to do so, but then at least we'll know a lot more about the dimensions of the problem.

Michael Kirsch, M.D. said...

Thank you, Howard, for clarifying what I suspected was your view. Are you concerned about the various potential downsides of a 'divestment' strategy?