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New Law Aims to Expose Big Pharma Influence on Physicians

Story Highlights
  • Financial relationships between physicians and drug companies have existed for decades.
  • Ties between doctors and the pharmaceutical industry have raised conflicts of interest concerns.
  • The Physicians Payment Sunshine Act has stirred controversy around conflict of interest policies.

It is no secret that the medical field is heavily influenced by the pharmaceutical industry. For many decades, health care professionals and pharmaceutical companies have enjoyed cozy financial relationships.1 Pharmaceuticals continuously interact with medical doctors (MDs) and Doctors of Osteopathy (DOs), the two types of physicians who are licensed for prescribe drugs in the U.S. in order to persuade them to promote and prescribe drugs and vaccines to patients. Physicians are then compensated in many forms for promoting patient use of pharmaceutical products.

Big Pharma funds medical education programs for physicians and then pitches new drugs to them. Pharma pays doctors for promotional speaking engagements and provides them with free drug samples and free meals, etc.2 To get an idea of the extent of these financial ties, the pharmaceutical industry paid physicians and hospitals at least $3.5 billion during only the last five months of 2013.3

While such ties favor the bottom line financial interests of both parties involved, they have raised serious questions about conflicts of interest in the medical field. At the heart of the conflicts of interest issue is whether physicians heavily influenced by the pharmaceutical industry are able to provide quality care to patients if they are unable to separate the interests of their patients with their own personal relationship with industry.1 

Drug companies are known for employing aggressive marketing strategies and the pharmaceutical industry is deeply rooted in the medical system. Some scholars map the pharmaceutical stronghold on physician attitudes and behavior to medical school…

Interaction between drug companies and doctors are pervasive. Relationships of doctors with drug companies begin when they are just medical students attending the various clinical OPD’s and wards, continue during internship and residency training, and persist throughout their professional careers.1

Over the years, the credibility of the medical profession from the patient’s perspective has continued to decline because of the relationship between physicians and industry.1 It is now being realized that relationships between doctors and the pharmaceutical industry are a central public health issue that must regulated and contained within reasonable boundaries.1 A growing number of critics are pointing out the danger of the too-cozy relationship between doctors and drug companies and are beginning to push for more transparency around these murky relationships.

The Physician Payment Sunshine Act

As part of the 2010 Affordable Care Act, the Physician Payment Sunshine Act, led by Senator Chuck Grassley (R-Iowa) and Senator Herb Kohl (D-Wisconsin), called for the first public release of all drug and device company payments to physicians.4 5 The law mandates that all manufacturers of drugs, medical devices and medical supplies who have at least one product covered by Medicare or Medicaid disclose payments and gifts they have made to physicians and teaching hospitals.6

As a result, in 2014, the Centers for Medicare & Medicaid Services launched a new website, Open Payments, which is a tool naming all doctors and teaching hospitals that received funds and gifts from drug companies.2 Since this database is in its early stages of development, users are advised to analyze the data with caution.3 4

In addition to promoting overall transparency, the aim of publically releasing these drug company payments is to provide patients with the ability to assess where their physician’s bias and financial interests may potentially lie.5 The data available through Open Payments raises legitimate concerns about whether some physicians are too closely tied to drug companies and are biased toward certain manufacturers when writing prescriptions and promoting use of pharmaceutical products to patients. According to ThinkProgress:

That data set begins to reveal a piece of what’s become a lucrative industry. Pharmaceutical companies spend nearly $20 billion annually marketing their products to physicians, efforts that yields profits of nearly $300 billion per year in prescription drug sales. At the peak of Big Pharma’s profitable relationship with the medical industry in 2007, more than 100,000 representatives made visits to more than 650,000 physicians across the country.7

Controversy on Open Payments in Medicine

Some critics of the Open Payments database are questioning if conflicts of interest questions are solely driven by moral outrage.2 Some argue that although, in theory, physicians and drug companies should essentially be striving for similar goals, their underlying financial relationship is always going to be perceived as suspicious, and that could have a negative impact on development of life-saving therapies.2

According to Vox, cardiologist Lisa Rosenbaum’s piece in the New England Journal of Medicine argues…

that the stigma against doctor-industry collaboration could have all sorts of negative effects. It might mean that effective drugs get to market more slowly. It might mean that experts with important views get ignored or silenced because they happen to work with drug companies. It might mean that, ‘life-saving therapies whose development requires the combined talents of clinicians and industry scientists don’t materialize.’8 2

Rosenbaum goes on to further express that… 

I’m not suggesting abandoning regulation. When the rules work, they protect us and our patients from fraudulent marketing and twisting of facts. But when rules merely cloak an anti-industry bias in the false promise of scientific virtue, we undermine potentially productive research collaborations, dissemination of expertise, and public trust.8

On the flip side, critics of the close financial relationship between physicians and drug companies have argued that clear evidence exists to demonstrate that ties between physicians and Big Pharma breed dangerous circumstances and jeopardizes quality medical care. In response to Rosenbaum’s argument questioning conflict of interest policies, three doctors—Robert Stenbrook, Jerome Kassirer and Marcia Angell wrote a rebuttal in the British Medical Journal stating:

Physicians and the public rely on journals as unbiased and independent sources of information and to provide leadership to improve trust in medicine and the medical literature. Yet financial conflicts of interest have repeatedly eroded the credibility of both the medical profession and journals. As the Institute of Medicine explained in its 2009 report, a conflict of interest is ‘a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.’10 The key issue is that ‘a conflict of interest exists whether or not a particular individual or institution is actually influenced by the secondary interest.’10 9

Given the complicated nature of the relationship between physicians and drug companies, coupled with the push for medical innovation, there are legitimate conflict of interest issues that need to be addressed by the medical community, including: Where should the line be drawn between industry and physicians in order to protect the patient?


References:

1 Bansal RK, Das S. Unethical Relationship Between Doctors and Drug Companies. Journal of Indian Academy of Forensic Medicine 2005; 27(1).
2 Belluz J. The Surprising Debate Whether Doctors Should Have Ties to Big Pharma Vox Science & Health June 4, 2015.
3 Belluz J.  Doctors and Hospitals Got At Least $3.5 Billion From Industry in the Last Five Months Vox Healthcare Sept. 30, 2014.
4 Ornstein C. What to be Wary of in the Government’s New Site Detailing Industry Money to Doctors. ProPublica.org Sept. 30, 2014.
5 Young J. Big Pharma’s Money Ties To Doctors Revealed. Kind Of. The Huffington Post Sept. 30, 2014.
6 Thomas K, Armendariz A, Cohen S. Detailing Financial Links of Doctors and Drug Makers. The New York Times Sept. 30, 2014.
7 Collins S. You Can Now Find Out How Much Big Pharma is Paying Your Doctor. ThinkProgess Oct. 1, 2014.
8 Rosenbaum L. Beyond Moral Outrage–Weighing the Trade-Offs of COI Regulation New England Journal of Medicine 2015; 372(21): 2064-68.
9 Steinbrook R, Kassirer J, Angell M. Justifying Conflicts of Interests in Medical Journals. The British Medical Journal 2015; 350.
10 Lo B, Fields M. Conflict of Interest in Medical Research, Education and Practice. Washington D.C. The National Academies Press 2009.

18 Responses to New Law Aims to Expose Big Pharma Influence on Physicians

  1. Michael McLaughlin Reply

    January 7, 2016 at 4:43 am

    A scary Big Pharma pronouncement made by Terry Bradshaw is that 1 out 3 people will get shingles in their lifetime. Very puzzling when I’ve haven’t known more than 10 people who have had shingles in my lifetime of over 60 years. Aren’t there laws about alarming the public with lies? I know there are laws against giving medical advice without a license.

  2. Chrissy Reply

    January 6, 2016 at 7:16 pm

    Here’s a story…

    I work in clinical trials. (Yes, I hate it and can’t live with myself, but that’s beside the point.)

    There is a doctor I work with who has over $50,000 in “stock” in a very large pharmaceutical company. A company that this doctor currently oversees 3 studies for.
    Anyway, when an employee finally discovered this conflict of interest and reported it to the IRB (the group of people who assess subjects’ rights are followed, GCP compliance, etc.) they said it in fact was not a conflict of interest because it wasn’t stock; the money in question is a retirement account that invests in the company.

    The company I work for, and the IRB, worked for days trying to figure out a way that this is not a “conflict of interest.” Apparently, there’s no interest in retiring.

  3. jenny M. Reply

    January 6, 2016 at 3:24 pm

    I’d agree with you, but the MD’s go along with the payment program, it’s forced servitude. And now our Tyrant in Chief is passing an unenforceable “executive action” to try and fool doctors so they can claim a patient they don’t like is mentally ill so they can’t ‘have’ guns.

    If you can, get into a more respectable line of work, become a Homeopathic doc or a Naturopathic physician if possible.

    Of course the unaffordable death care act doesn’t let those doctors get in on any insurance money…couldn’t let people actually be cured of anything, oh no….

  4. Bobby Davis Reply

    January 6, 2016 at 3:19 pm

    Our healthcare system sucks! I won’t use it unless I absolutely have to and I won’t take drugs either. Obamacare has made it impossible for seniors to receive proper care. Being on Medicare, I now have to go to my eye doctor twice (each visit is $50) to have all the eye tests done that use to be completed in one annual visit. The insurance companies won’t pay for compounded drugs like Armour Thyroid which is a natural thyroid medication that costs much more than the synthetic stuff. The Big Pharma companies, the insurance companies and the government with the help of Obama’s doctor friends (not all doctors are alike) caused this fiasco. Healthcare needed to be changed, but not the way Obama did it. We need market based insurance coverage where insurance carriers compete across state boarders and need to wrangle in the Big Pharma companies who create drugs that kill. How many advertisements do you see by PI Lawyers telling you if you’ve been injured by taking this drug or that one, call us you may have a case. There’s a new one that springs up every month or so. People need to be educated about how to take care of the human body and eat properly and exercise. Healthcare today sucks! It is a vehicle for insurance carriers, Big Pharma and doctors to earn a very lucrative living and for the government to control your life.

  5. Kristina Reply

    January 6, 2016 at 3:06 pm

    Rather than drive the fixes to the pharma-doctor conflict of interest problem from the vendor/pharma side, how about driving it from the doctor side. Attorneys have various ethics rules for their professional licensing. Why not make it an ethics rule for medical licensing that doctors not take money, product, or any other free item or service (including but not limited to travel accommodations) from a pharmaceutical vendor, directly or indirectly. Rationale for the rule is to curb conflict of interest which compromises the doctor’s judgment in determining remedies for patients. Penalty for violation should be suspension of their license. A similar rule should be put in place for medical schools for pharmaceuticals. The recent law that is supposed to provide transparency for pharma donations to doctors would help implement this idea, and catch doctor’s who accept pharma money. http://www.thevaccinereaction.org/2015/12/new-law-aims-to-expose-big-pharma-influence-on-physicians/

    A Federal law should also be put in place to bar incentives and penalties to doctors or schools for implementation of vaccines. This is aimed at CA SB277 which contains a reward program for schools that achieve a given percentage of vaccination in their student population. The rationale is that such incentive or penalty programs do not take into account the percentage of students in a given school population who cannot take vaccination and/or have vaccine reactions. These programs compromise the school and the doctor’s judgment for vaccinating an individual student. Penalty for violation should be withdrawal of certain Federal funding.

    Thanks for carrying these ideas forward!

  6. Cali physician Reply

    January 6, 2016 at 2:30 pm

    As a physician, this article/legislation is upsetting to me. Once again, politicians are trying to pass the buck and blame physicians. I have never received a dime from a drug company and there has already been legislation of this kind such that we cannot even receive so much as pens anymore from the drug company’s.
    The politicians are the ones that are in the drug company’s pockets and pass legislation requiring physicians to give certain drugs, primarily vaccines. The government regulates all of this in the form of reimbursements for medicare and medicaid. If a patient is admitted to the hospital, there is a nurse who’s sole responsibility is to ensure that patients receive all of their vaccinations and if they are admitted for chest pain, she must ensure that they are started on statins, beta blockers, aspirin, etc, in order for the hospital to receive payment for that patient. Pediatricians will kick unvaccinated patients out of their clinics because it affects their numbers that base all of the government reimbursements. Since most patients these days have some form of government insurance, you cannot operate without receiving your reimbursements from the government and therefore must comply with all of their medication and vaccine requirements. The CDC and FDA are also government bodies who mandate policy such as vaccines.
    Lets call a spade a spade and place more blame on politicians instead of physicians

  7. Colorado Reply

    January 6, 2016 at 12:03 pm

    Seeking ethical accountability within the confines of modern medicine? Keep dreaming. Buyer beware and protect yourself. Institutionalized and chartered businesses which are supposed to provide a check to the balance, have been absolutely and irreconcilably corrupted. When the FDA gets paid to approve, the check to the balance is officially broken. I remember a time in this country when violations of ethical rules could land someone in jail, or at least such violations would most certainly cost them their job. Thanks again to the major medical institutions, and educational providers, for completely abandoning ethics. When an educator has to censor this kind of material, they’ve lost all credibility as well. We’re talking RICO and monopolization of the industry.

  8. Frances Nowve Reply

    December 31, 2015 at 11:59 am

    I am opposed to mandatory vaccinations. Get your laws off my body.

    • Law Reply

      January 6, 2016 at 11:04 pm

      Agreed. Eliminate mandatory vaccinations.

      We have the inherent inalienable 100% equal right of bodily intake and exclusion.

      Consider that if bodily intake and exclusion is not an inherent inalienable 100% equal right, that others can dictate what goes and does not go into ones body. This would be more than vaccines, but also food and drink.

      I recommend against consuming alcohol, currently illegal drugs, cigarettes, and many foods. Since I support the 100% equal inherent inalienable right of bodily intake and exclusion, I oppose the prohibition on alcohol, drugs, etc. Making things legal does not make it right. Making things illegal does not make it wrong or prevent law breakers.

      We have the inherent inalienable 100% equal right of bodily intake and exclusion.

    • Tiffany Huebner Reply

      January 9, 2016 at 8:34 am

      Amen.

  9. Patrck McGean Reply

    December 29, 2015 at 11:31 am

    How do we break the chains binding our doctors to the drug companies who really don’t want to heal anyone? Add organic sulfur a crystal food to your diet and your trips to the doctor may cease.
    The accountability is ours, our health our responsibility, our biology none of which is synthetic. Synthetic is way pHarma rolls for the patents yet no part of your biology is synthetic.
    2016 the end of drug companies period. Remember this when you invest we dislike collateral damage, like autism and Alzheimer’s both vaccine damage.
    1944 the Judgment of Nuremberg was to hang all of the chemists, the Judgment remains an open case, and we have ropes.
    Sulfur twice day is similar to an apple a day, no doctors.
    Last note for doctors who vaccinate and CEOs who make vaccines, are pedophiles.
    Bankruptcy is the only cure for the influence peddling of pHarma.

  10. Jane Reply

    December 29, 2015 at 9:16 am

    It’s funny, I’ve been a doctor for 20 years and have never received money from a pharmaceutical company.

    • Leah Shirokoff Reply

      January 6, 2016 at 11:47 am

      That sounds good, but the pharma companies do not offer money, they are not allowed to. They offer speaking engagements or educational opportunities in prime vacation spots, paid and/or covered financially.

      • jenny M. Reply

        January 6, 2016 at 3:26 pm

        It’s another form of currency…more like bribes, really.

  11. Post60 Reply

    December 25, 2015 at 2:28 pm

    The age of public accountability is only just beginning. Baby steps.

  12. David Weiner Reply

    December 25, 2015 at 11:17 am

    Trying to solve this problem on the back end will never work.

    The only way to eliminate undue pharmaceutical (or other) influence on medical practice is to establish a free market in health care.

    Yes, that’s right, dismantle the whole apparatus of medical licensing, “regulation”, and patents which enable the Big Boys to maintain their cartel.

    Free and open competition … that is the doctor’s order that will end the corrupt, bloated, inefficient, and dangerous system that we have today. Nothing else will.

    • Frank Reply

      December 28, 2015 at 2:15 pm

      We agree completely. Rather than restrictions on every aspect of our lives, eliminate the various federal bureaucracies, including the Department of Education (Indoctrination), so that people will become responsible for their own actions.

      Teach young people, and other human beings, to analyze data and think for themselves. Rather than what money a politician receives, what does the politician do in his government service should determine whether someone votes for him or not. Personally, I don/t care where he receives his outside money, I care about how he votes. I don’t need the FEC or the SCOTUS to tell me what a politician does with his money. I can discern how he votes and how he upholds his Oath of Office under the U.S. Constitution.

      Thank you for your post.

      • TeeJae Reply

        January 6, 2016 at 7:53 pm

        Friendly piece of advice: You should care *where* a politician receives his money, because that often determines *how* he votes.

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