“One of the ques­tions that comes up is, is there al­ways a hid­den agenda?”

Modern Healthcare - - Special Report -

ing physi­cian hap­pens to hold buy­ing power by serv­ing on a hos­pi­tal pre­scrip­tion for­mu­lary com­mit­tee, for ex­am­ple, or hold­ing sway over the pur­chas­ing de­ci­sions of a group prac­tice.

Mar­i­lyn Field, se­nior pro­gram of­fi­cer at the In­sti­tute of Medicine who di­rected a 2009 study, Con­flict of In­ter­est in Med­i­cal Re­search, Ed­u­ca­tion and Prac­tice, says physi­cians need to stay clear-eyed about why a med­i­cal-prod­uct maker would ask them to serve as an ad­viser.

If the pri­mary func­tion of serv­ing on a board looks more like mar­ket­ing than science, doc­tors ought to be wary, she says.

“If they’re just there to pro­vide a rep­u­ta­tional ben­e­fit to the com­pany, that is, this com­pany has an ad­vi­sory com­mit­tee with all these im­por­tant peo­ple on it but they’re not pro­vid­ing a le­git­i­mate ser­vice, then you could raise ques­tions whether the clin­i­cians have put them­selves in a sit­u­a­tion where there’s a se­ri­ous risk of bias,” Field says. How­ever, “risk of bias” is the op­er­a­tive term. Even many of the most skep­ti­cal ob­servers of physi­cian-in­dus­try col­lab­o­ra­tion say ad­vi­sory re­la­tion­ships can carry real ben­e­fits, par­tic­u­larly in this age of rapidly evolv­ing med­i­cal ad­vances. The po­ten­tial for bias doesn’t mean it ex­ists.

So if the is­sue is per­cep­tional, one key ques­tion a physi­cian should con­sider is how pa­tients would feel if they knew about the doc­tor’s role in ad­vis­ing a com­pany whose prod­ucts he or she is pre­scrib­ing. Crit­ics say pa­tients will likely be wary of such co­op­er­a­tion, par­tic­u­larly if the com­pen­sa­tion for ad­vis­ing the in­dus­try firms is high.

Learn­ing more about such physi­cian re­la­tion­ships with in­dus­try should be­come much eas­ier in the near fu­ture.

Among the hun­dreds of new re­quire­ments in the Pa­tient Pro­tec­tion and Affordable Care Act is Sec­tion 6002, the Physi­cian Pay­ment Sun­shine Pro­vi­sion, which will re­quire com­pa­nies such as drug and de­vice­mak­ers to track any pay­ments to doc­tors over $10, be­gin­ning in 2012. In 2013, those dis­clo­sures will be­come pub­lic in­for­ma­tion on a search­able web­site.

Com­pa­nies cov­ered by the Sun­shine Pro­vi­sion will have to re­port mon­e­tary and non­mon­e­tary com­pen­sa­tion, along with the full name and busi­ness ad­dress of the doc­tor, the amount of the pay­ment and the rea­son for it.

The pro­vi­sion fol­lows sim­i­lar leg­is­la­tion in states such as Min­nesota and Ver­mont, Derse says. “You can dis­close it to your em­ployer, but now your lo­cal news­pa­per and your pa­tients can look you up on data­bases,” he says. “The ques­tion that we’ve asked rhetor­i­cally—how would this look to your pa­tients if they knew this in­for­ma­tion?—has be­come re­al­ity.”

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