Will Disclosure Quiet the Industry’s Critics?
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Will Disclosure Quiet the Industry’s Critics? Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009
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Will Disclosure Quiet the Industry’s Critics?. Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009. Why a Doctor Gifts Registry?. Transparency/accountability to patients. - PowerPoint PPT Presentation
Transcript of Will Disclosure Quiet the Industry’s Critics?
Will Disclosure Quiet the Industry’s Critics?
Peter Lurie, MD, MPHDeputy Director
Health Research Group at Public Citizen
Presented before The National Disclosure SummitWashington, DCMarch 5, 2009
Why a Doctor Gifts Registry?
• Transparency/accountability to patients
Statement by American College of Physicians
“What would my patients think about this arrangement? What would the public think? How would I feel if the relationship was disclosed through the media?”
Source: Ann Intern Med 2002;136:396-402
Why a Doctor Gifts Registry?
• Transparency/accountability to patients
• Restore trust in medical profession
• Facilitates kickback investigations
• Transparency/accountability to providers
• Transparency/accountability to payors
• Promotes research (esp. if names provided)
• Facilitates journalistic investigations
Uses by Journalists
• Investigative pieces by local journalists
• Comparisons by specialty
• Links to “thought leaders”
• Links to state disciplinary actions
Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004
Vermont MinnesotaThreshold $25 $100
Trade secret exemption?
Yes No
Electronic? Yes No
Reporting period 2 years 3 years
Median physician gift >$100 (maximum)
$250 ($20,000) $1000 ($922,239)
Total physician gifts $3.2 million $22.4 million
Sources: JAMA 2007;297:1216-23; JAMA 2008;300:1998-2000
Purpose of Payments >$100 to Physicians in Vermont, 2002-4
By Payment
Education
Detailing
Speaker
Marketing
Consulting
Unspecified/Other
By Value
Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004
• High rates of underreporting– Companies report $millions one year, nothing the next
• Responses non-standardized– Aggregation by physician and by gift
• Exemptions– Samples– Research studies
• Limited accessibility– Lack of online submissions or reports– Need to file lawsuit in Vermont
• Lack of national standardization
Problems with the Physician Payment Sunshine Act, 2009
• Exclusions– Samples– Research on unapproved products– Gifts totaling <$100 per year– Gifts to other professionals
• No payments to organizations– MECCs and PBMs– Patient groups– Hospitals and medical schools– Professional organizations
• No judicial review• Low penalties
– Intentional non-reporting: cap of $1 million/year
Framework for AddressingConflict of Interest
Potential Conflict
Legal Restrictions Policy Restrictions Disclosure
Research Payments to Physicians
Research Payments
Legal Restrictions Policy Restrictions Disclosure
Pool of Research FundsSome journals
Some presentationsNot DesirableNot Feasible
Non-research Payments to Physicians
Non-research Payments
Legal Restrictions Policy Restrictions Disclosure
Institutional Restrictions State or Federal DatabasesLimited Political Feasibility
Boston UniversityUniversity of Michigan
University of PennsylvaniaYale University
Stanford University
Boston Medical CenterGeisinger Health System
Affinity Health SystemKaiser Permanente
HealthPartners
Pharmaceutical Company Promotional Expenditures, U.S., 2004
Samples
Detailing
DTC
Meetings
Journal Ads
Unmonitored/Other
• Total expenditures– Promotion: $57.5 billion– Research: $31.5 billion
• As % of retail sales– Promotion: 24.4%– Research: 13.4%
• $61,000 on promotion per physician
Source: PLOS Medicine 2008;5:e1
Q: Will Disclosure Quiet the Industry’s Critics?
Q: Will Disclosure Quiet the Industry’s Critics?
A: No
