The vast majority of physicians in the United States take gifts from the pharmaceutical industry. Thanks to the Sunshine Act, you can find out exactly how much your physician (or any doctor) gets from which drug companies.
A long-time editor of a prestigious medical journal started his editorial on physicians’ conflicts of interest by describing a fantasy: Doctors treat patients using simply the best evidence and their experience. They are not influenced by money or self-interest.
This is, of course, nonsense, he wrote. There is a reason pharmaceutical companies spend billions of dollars on the influencing, education, and entertainment of doctors around the world.
The vast majority of physicians in the United States take gifts from the pharmaceutical industry, and, ironically, cardiologists, whose practice centers around diseases that can largely be prevented and treated with lifestyle changes, receive the most payments of all. A previous compilation of surveys from the 1980s and 1990s found that, on average, doctors met face-to-face with drug industry representatives about once a week. Today, your family doctor may meet with drug company employees on average 16 times a month. There are only 20 workdays a month, so that’s nearly every day.
What does the public think about this? Only about half even appear to know what’s going on. Therefore, if 83% of doctors receive gifts, it is likely that a significant percentage of patients are not aware that their personal physician receives industry gifts. We’re not just talking about a token Viagra paperweight or soap dispenser. For marketing, pharmaceutical companies spend $15,000 per physician every year, making conflicts of interest one of the most pressing problems in American health care.
How do doctors feel about it? Most generally approve of the gifts. However, tellingly, physicians don’t want gift relationships made public. Physicians disagreement that it is inappropriate to accept gifts, but their reluctance to disclose the gift relationship to the public, suggests that they must recognize that the public would not appreciate the practice.
To analyze how doctors resolve this contradiction, researchers conducted a series of physician focus groups. It turns out physicians use a variety of denials and rationalizations, including avoiding thinking about it and denying responsibility. Physicians readily acknowledged the inherent conflict of interest, but this didn’t stop them. In fact, some complained that the gifts were getting more modest.
We [doctors] tend to deny that we have any conflict of interest if a pharmaceutical company buys us a nice dinner. We tend to insist that it won’t affect our judgement in any way, as if drug companies just like wasting money on purpose! Most physicians contend that their colleagues are susceptible to industry influence, but not them.
Though physicians don’t want these gift relationships to be public, that’s just too bad. Thanks to Republican Senator Chuck Grassley, the Sunshine Act was inserted into Obamacare. For the first time, patients will now be able to see what, if any, financial ties their own doctor has with a drug or device maker.
The Sunshine Act was designed to give patients some insights when choosing a provider, and law enforcement agencies can also use it see who’s getting money from industry to investigate illegal kickback schemes. Right now, it might just be embarrassing, but this could allow attorneys general to go after doctors to see the kinds of incentives they may be getting for writing a lot of prescriptions. The database is live right now at openpaymentsdata.cms.gov/search/physicians or, for a more user-friendly version, Propublica’s Dollars for Docs page. The drug industry spends billions trying to influence doctors, and, for the first time, you can see if your physician, or any physician, has their hand out.
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