24 Nov Open Payments Site Reveals Drug Company Payments to Doctors
Pharmaceutical companies have never been reluctant to use their wealth and influence to steer the medical profession toward drug-based cures. Miracle drugs for this and wonder drugs for that are hitting the market faster these days than new brands of soft drinks, but none of them will be able to carve out a niche in the marketplace without the support of doctors willing to recommend them to patients.
There will always be disagreement about what the benefits handed out to doctors, research institutes and teaching hospitals by pharmaceutical interests actually represent. Is it, as the drug companies insist, a way to get the word out about outstanding medicines that have the potential to help a lot of people? Or, in a greedy quest for profits, are the pharmaceutical manufacturers simply bribing pliable doctors while attempting to subtly influence the medical profession as a whole, as critics and skeptics charge? Or is it, as many would suggest, a combination of both factors at work at the same time?
Different viewpoints and conclusions on the issue are to be expected, and it may never be entirely clear who is wrong and who is right in every instance. But in the final analysis, medical patients have a right to know what kind of relationships their physicians have with the suppliers of the drugs they are being prescribed. Full disclosure of the specific connections between medical practitioners and medical supply companies would reveal any potential conflicts of interest, and it would then be up to the patients to decide how to proceed.
Nothing to Hide?
Should such data become widely available, many if not most patients would probably choose to stay with physicians they had already learned to trust. Nevertheless, if there is nothing to hide, then nothing should be hidden. If some patients chose to disqualify certain medical providers based on financial connections they considered troubling, they would be well within their rights to do so.
In order to promote this sort of transparency, the Affordable Care Act that brought expanded health insurance to the American people also mandated the creation of a website that would provide detailed information about the links between pharmaceutical companies, medical device makers and the broader medical profession. Known as the Open Payments website, this new online database went live in September and is now available for public scrutiny. While reviewers have criticized the website for excessive complexity, watchdog groups and medical investigators have been pouring over the data and have begun to release detailed analyses of what the Open Payments site reveals.
At this time, the Open Payments database covers only financial transactions made between August and December of 2013. Within this data set are thorough records on payments made by pharmaceutical companies and medical device manufacturers to physicians and teaching hospitals. These payments are broken down into three categories: general payments, which means funds transferred directly to doctors in the form of speaking fees, consulting fees, travel reimbursements to attend conferences, meals, gifts and so on; research payments, largely intended to fund studies of newly created products; and ownership payments, which means compensation paid to medical personnel who are financially invested in particular drugs or medical products.
Between August and December of last year, doctors, medical researchers and teaching hospitals received 4.4 million payments totaling $3.5 billion from their benefactors in the medical product supply industry (the pharmaceutical companies and medical device makers). This included $380 million in the general payment category, mostly covering speaking and consulting fees for doctors. The majority of overall funding went to teaching hospitals and was largely intended to support research.
Approximately 500,000 doctors and 1,360 teaching hospitals were identified as recipients of this largesse. However, the number of beneficiaries is actually higher because about 40 percent of the listed payments actually don’t identify a specific donee. This covers 64 percent of the overall payment amount, which naturally is a significant omission for a website that has promised to be comprehensive. It remains to be seen if the loopholes that allow this evasion are eventually closed, but for now the concept of “full disclosure” is being treated as more of a guideline than a rule.
Shining the Light Into Medicine’s Darkest Corners
In theory, information like that being presented on the federal government’s Open Payments website will help foster transparency in the medical industry. This data will allow patients to discover whether their doctors might have something to gain from their recommendation of specific treatment strategies or products. It will also help the public and public interest groups develop a greater understanding of how pharmaceutical companies use their wealth to promote a pro-drug agenda in the aggregate.
But at the present time, the information released by the federal government is of limited usefulness because it is not comprehensive and lacks context. It simply isn’t possible to know for certain what all of these donations mean, or what the intent behind them is, based on just five months’ worth of records. And since almost two thirds of the money doled out went to currently undisclosed sources, the ability to draw meaningful correlations from the available data is even more restricted.
This problem may not represent a permanent state of affairs, however. As the years pass and more data is collected, it may, for example, be possible to draw clear conclusions about the relationship between pharmaceutical donations and patterns of drug-prescribing by physicians. And even in the short term, patients who want to know about potential conflicts of interest may be able to find scattered bits of useful information from this new government website. All in all this represents a significant step forward in a healthcare system where shadowy relationships and hidden agendas have too often ruled the day.
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