Last week, the US Senate Special Committee on Aging held hearings about financial relationships between pharmaceutical companies and doctors. Those testifying included Dr Jerome Kassirer, Professor, Tufts University and author of “On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health,” Marjorie Powell, Senior Assistant General Counsel for the Pharmaceutical Research and Manufacturers of America (PhRMA), Dr Greg Rosenthal, an ophthalmologist, and Dr Robert Sade, chair of the American Medical Association’s Council on Ethical and Judicial Affairs. The hearings did not get a lot of coverage, but I could piece together some of the testimony from articles in the Milwaukee Journal-Sentinel, New York Times, and United Press International. The results are striking:
Senator Herb Kohl (D-Wisconsin): “Gifts and payments can compromise physicians’ medical judgment,” Kohl said. “Efforts are needed to curb this.” While such practices “are not illegal, they need to be disclosed.” [UPI]
Dr Jerome Kassirer: “Doctors are human; they respond to financial incentives.” And, “financial connections have a negative influence on the quality of care,” but “the response to this has been inadequate.” [UPI] So, “these marketing efforts are thinly disguised bribes.” [MJS]
Senator Claire McCaskill (D-Missouri): “We must acknowledge that a lot of what goes on between the pharmaceutical industry and physicians is lobbying and that’s not patient first.” [MJS]
Dr Greg Rosenthal said drug companies are exerting increasing control over what research to conduct and what results to report. [MJS]
Dr Robert Sade: Interaction between doctors and drug companies “is necessary to the free flow of valid scientific information,” The AMA has “continually revised” codes on such interactions stating that any gifts changing hands must “mainly benefit the patient and be of modest value,” with no strings attached, he said. [UPI]
Marjorie Powell: “testified that doctors’ prescribing decisions are largely based on what drugs health insurers list on their formularies, not on the promotional activities of drug companies, which she said are geared mainly to ‘making sure doctors know a drug is available and how to use and not to use it.‘ [UPI]
“‘Doctors are trained professionals; they know how to evaluate the information they receive,’ she said.” [UPI]
“She added that free drug samples given to doctors should not be disclosed as ‘gifts,’ calling them ‘tools’ for physicians and needed by patients who are uninsured and otherwise can’t afford them.” [UPI]
“Powell argued that drug companies, reacting to public pressure, have already pared down their extravagant wooing of doctors that went on in the past.” [UPI]
Finally, Ms Powell “is not in favor of full disclosure and a national registry now. She said the industry follows its own code of ethics, and both the Federal Drug Administration and Department of Health and Human Services play a role in regulation.” [MJS] Furthermore, “Ms. Powell told the committee that similar state efforts had become enmeshed in difficult details — like deciding whether free drug samples should be classified as gifts. ‘There are those kinds of complexities that would make a registry very difficult,’ she said.” [NYT]
How fascinating. Kudos for Jerry Kassirer for his blunt assessment. On the other hand, note that Dr Sade of the AMA side-stepped the issue: no one seems to challenge the necessity for the free flow of scientific information. But what does such information exchange have to do with pharmaceutical companies giving gifts and making payments to physicians. Finally, is Ms Powell serious in her contention that drug company marketing has no effect on physicians? If so, why in the world would the companies pay such vast sums to support their marketing efforts to physicians?
We have called before for full and detailed disclosure of all conflicts of interest affecting anyone with decision making authority in health care. A federal registry of all pharmaceutical payments to physicians would be a step in that direction. But why not have a registry of all payments to all health care academics, all health care academic leaders, all health care not-for-profits, and all individuals who lead any kind of health care organizations? Why not have a registry of payments by biotechnology companies, device companies, managed care organizations and insurance companies, health care information technology companies, etc, etc? Maybe the magnitude of such disclosures would suggest that conflicts of interest are so pervasive that we will need not just to disclose, but to ban them. But that would be a very uncomfortable idea to all the people and organizations who are currently benefiting from them.