Quid pro quo
The nothing-tosee-here relationships between physicians and medicalproducts companies could soon be coming to a close
When Senate lawmakers began probing in 2007 whether undisclosed financial relationships between physicians and medical-product companies influence patient-treatment decisions, the vast majority of companies and providers resisted efforts to make those relationships public.
Those protesting voices have quieted over the past year, however, largely because of a litany of high-profile cases where physicians appear to have put lucrative consulting agreements ahead of patient safety. One of the most glaring examples came to light last March when Baystate Medical Center, Springfield, Mass., said it had discovered that Scott Reuben, an anesthesiologist with the 653-bed hospital, fabricated results in 21 painkiller studies, many appearing in the journal Anesthesia & Analgesia.
Two of the pain relievers—Celebrex and the recalled Bextra—that Reuben published favorable findings on were from Pfizer, which paid him a still undisclosed amount in speaker fees and gave him five research grants between 2002 and 2007. During that period, both Celebrex and Bextra were linked to heart attacks in patients using the drugs, and in January 2008 Pfizer reached an agreement with federal pros- Lawmakers have been pushing for more oversight since 2007, and a series of highprofile cases might finally bring that change. ecutors to pay $2.3 billion in fines to settle charges that it illegally marketed Bextra. Many of Reuben’s studies on those and other drugs have been used by clinicians as guidelines for prescribing pain treatment regimens.
Reuben’s case is hardly isolated, and such revelations have pushed companies and providers alike to acknowledge and grapple with the question of how to prevent such abuses. “When we held our first hearing 2½ years ago, the industry denied there was a problem,” said an aide with the Senate Special Committee on Aging, which under the leadership of its chairman, Sen. Herb Kohl (D-Wis.), is one of two Senate committees leading the probe. The aide spoke on the condition of anonymity.
But now the healthcare industry appears poised, even if reluctant, to remove the veil that has cloaked industry-provider financial ties. An increasing number of provider organizations, medical-device companies and drugmakers have begun voluntarily disclosing those relationships, and the proposed Physician Payments Sunshine Act, which would mandate disclosure, may soon become law as part of Congress’ healthcare overhaul. The proposed law could require online publication of everything from how much companies spend to sponsor specific continuing medicaleducation events to their donations and grants to patient advocacy groups, fees to doctors for teaching, royalty and speaking engagements and research awards to provider and professional-medical organizations.
Still, much to do
But even with such progress, advocates of the current disclosure movement say much work remains to be done if the proposed law is going to have sufficient teeth and achieve the type of transparency needed to ensure patient care is free of financially induced bias.
“The real question is the level and depth of disclosure,” said Eric Campbell, the director of research at the James J. Mongan Institute for Health Policy at Harvard University. “Disclosure is a very broad word, and voluntary policies about who you have to tell and what you have to disclose in terms of the dollar amount aren’t consistent.”
A federal law requiring disclosure is an important step in rectifying such discrepancies, Campbell said. But he also insisted that a new law will have little success in tempering