We trust umpires, referees and judges because they are supposed to be impartial. They have strict ethical standards that are intended to prevent conflicts of interest. That’s why they are not allowed to accept money from teams or organizations they are overseeing.
Imagine for a moment that the umpire calling balls and strikes during the World Series was later found to have accepted gifts or money from one of the teams. There would be such outrage that organized baseball might have a hard time recovering.
Why Aren’t Doctors Held to Similarly Strict Standards?
No such concern exists when physicians take money from the pharmaceutical industry. Our doctor should be like an impartial judge, determining the best treatment for us based purely on the evidence and our particular health condition. Money should play no part in the decision to write a prescription.
Dialing Dollars for Doctors…600,000 of Them!
The federal government has started requiring the makers of drugs and devices to report how much money they pay to physicians and teaching hospitals under something called the Sunshine Act. The first full year of numbers are just in and they are shocking. During 2014 the industry spent roughly $6.5 billion on 607,000 doctors and 1,121 hospitals.
Let that sink in for a moment. Over 600,000 physicians were reported to have received money from either the pharmaceutical or device industry last year. That might not mean much until you factor in that there are less than 800,000 doctors providing patient care in the U.S. So, roughly three out of four physicians seeing patients took money from Big Pharma. Some took only a few dollars. Others received millions.
A big chunk of that money ($3.23 billion) was related to “research-related activities.” On the surface that sounds perfectly reasonable. Doctors should get paid to do cutting-edge research that will lead to important drug advances. What is not mentioned, though, is that a big chunk of this “research” is for medicines already on pharmacy shelves.
A Dirty Little “Research” Secret
Years ago a drug company insider told us a dirty little secret. He himself, although highly placed, was an ethical physician appalled at what he observed. He revealed that many of the clinical trials were not designed to advance science or discover new uses for old drugs. He disclosed that a surprising number of the studies were supervised and funded by the marketing arms of drug companies rather than the research side. They provided a sanitized system for Big Pharma to funnel money to doctors for research that was never intended to be published.
Many of the so-called studies were intended to “familiarize” doctors with expensive medicines. A doctor who believes he or she has helped contribute to the development of a particular medication is likely to feel that it is special. Participation certainly could influence a doctor’s judgment about a certain drug or pharmaceutical company. Given the choice of prescribing an older generic product or a newer and pricier brand name drug, some physicians might opt for the medication they had been paid to “study.”
Consulting Fees, Talks, Travel, Food and Lodging
The industry spent roughly $370 million for doctor consultations. Over $400 million went for travel, lodging, food, beverages and entertainment. In many cases doctors are incentivized to do the “dog and pony show.” That means they get paid a pretty penny to stand up in front of their colleagues and discuss the benefits of a particular company’s new drug at a nice restaurant. Last year the industry spent over $600 million on such “promotional speaking.”
Once a doctor gets the reputation for being drug company friendly, she may get hired by other pharmaceutical firms. According to a story (“A Pharma Payment A Day Keeps Docs’ Finances Okay”) co-published by ProPublica (July 1, 2015) and NPR’s Shots blog, one physician received over half a million dollars last year from 29 drug companies for consultation and speaking gigs.
What Do You Think?
We recognize that some drug company payment to doctors is justified. Real research is a time-consuming and important endeavor and doctors should be compensated appropriately.
Some doctors may be able to remain objective despite getting big sums from pharmaceutical manufacturers for consulting and promotional speaking. But if we expect referees and umpires to remain impartial and never accept money from the teams they are overseeing, then perhaps it is time for doctors to adopt similar standards.
When a physician examines a patient, makes a diagnosis and then recommends a course of treatment it should be determined exclusively on what is best for that patient without any potential conflict of interest. Although most physicians believe they do that every time they see a patient, research demonstrates that:
“Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias… In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence.”
The Journal of Law, Medicine & Ethics, Fall, 2013
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