The long-time editor of a prestigious medical journal started his editorial on physicians’ conflicts of interest describing a fantasy that doctors treat patients using simply the best evidence and experience, rather than being influenced by money or self interest. This is, of course, nonsense. There is a reason pharmaceutical companies spend billions of dollars on influencing, educating, and entertaining of doctors around the world.
The vast majority of physicians in the United States take gifts from the pharmaceutical industry, and, ironically, cardiologists, whose practice centers around diseases that can largely be prevented and treated with lifestyle changes, receive the most payments of all. A previous compilation of surveys from the 80s and 90s found that, on average, doctors met with drug industry representatives about once a week. Today, your family doctor meets with drug company employees 16 times a month. There’s only 20 workdays a month, so that’s nearly every day.
What does the public think about this? Only about half even appear to know what’s going on. So, if 83% of doctors receive gifts, it is likely that a significant percentage of patients are not aware that their personal physician receives industry gifts. And, we’re talking more than just a Viagra paperweight or soap dispenser. For marketing, pharmaceutical companies spend $15,000 per physician every year, making conflicts of interest one of the most pressing problems in American health care.
How do doctors feel about it? Most generally approve of the gifts; however, tellingly, physicians do not want gift relationships made public. Physicians do not agree that it is inappropriate to accept gifts, but their reluctance to disclose the gift relationship to the public suggests that they must recognize that the public would not appreciate the practice. To analyze how physicians resolve this contradiction, researchers conducted a series of physician focus groups. It turns out physicians used a variety of denials and rationalizations; they avoided thinking about it, denied responsibility…
Physicians readily acknowledged the inherent conflict of interest, but this didn’t stop them. In fact, some complained that the gifts were getting more modest. We tend to deny that we personally have any conflict of interest if a pharmaceutical company buys us a nice dinner. We tend to insist that it won’t affect our judgment in any way, as if drug companies just like wasting money on purpose. Most physicians contend that their colleagues are susceptible to the industry’s influence, but not them.
Though physicians don’t want these gift relationships to be public, that’s just too bad, because, thanks to Republican Senator Chuck Grassley, the Sunshine Act was inserted into Obamacare. And, so, for the first time, patients will now be able to see what, if any, financial ties their own doctor has. Doctors can’t hide anymore. This will give patients some insights when choosing a provider, and once the database goes live, law enforcement agencies can also investigate kickback cases to see who’s getting money from industry.
Right now, it might just be embarrassing, but this could allow attorneys general to go after doctors to see the kinds of incentives they may be getting for writing a lot of prescriptions. And, the database is live right now. Go to openpaymentsdata.cms.gov/search or for a more user-friendly version, Propublica’s Dollars for Docs page. The drug industry spends billions trying to influence doctors, and, for the first time, you can see if your physician, or anyphysician, has their hand out.
Senator Grassley hoped this would help save our nation money. It could reduce healthcare costs if patients view such doctors as less trustworthy, and choose doctors less in bed with industry or could change physician behavior. They may want to avoid financial relationships with companies to guard against this patient distrust or becoming the target of an exposé or investigation. Or, they could just try to cover it up. This is from the American Academy of Family Physicians, advising physicians how to avoid getting burned by the Sunshine Act.
For example, drug companies now have to report when they give doctors free meals valued at over $10. So, should family physicians just stop accepting free food from drug companies? No way—you just have to give the drug sales reps the right head count, so the meal cost dips below $10 per person.
The former long-time editor of the New England Journal of Medicine said it best: although the spotlight has been on disclosing doctors’ financial relationships with industry, the problem with conflicts of interest is not the lack of disclosure but the existence of the conflict itself. Rather than just disclosing them, the best approach to financial conflicts is to have none.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
No wonder physicians undervalue lifestyle interventions! See The Actual Benefit of Diet vs. Drugs and Why Prevention is Worth a Ton of Cure. Inundated by Big Pharma without so much as a free mug from Big Broccoli Physicians May Be Missing Their Most Important Tool. And even worse, sometimes the drugs can do more harm then good. See my video on How Doctors Responded to Being Named a Leading Killer.
Financial arrangements can affect prescribing behavior for more than just drugs. See my recent video Should We All Get Colonoscopies Starting at Age 50?.
PS: I have never knowingly accepted gifts from the pharmaceutical industry, but “knowingly” is an important caveat. If you search for my name in the Dollars for Docs database you’ll see I apparently accepted money from a vision care company two years ago. I was giving a continuing medical education lecture at an optometric physicians conference and unbeknownst to me they had the corporation pay for my travel and lodging.
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This article and video republished with permission from NutritionFacts.org
Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous “meat defamation” trial.
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