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