Quid pro quo

The noth­ing-tosee-here re­la­tion­ships be­tween physi­cians and med­i­cal­prod­ucts com­pa­nies could soon be com­ing to a close

Modern Healthcare - - Cover Story - Shawn Rhea

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

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