Bringing Sunshine to Medicine

We all know there is money in medicine- but how do we feel about money around medicine?

Physicians [and more recently Advance Practice RNs and Physician Assistants] have enormous financial power through their legal authority to write prescriptions. With a stoke of their pens whole industries- especially the pharmaceutical and medical device industries- can flourish or flounder.

Enticing people with prescription power to use your product makes good business sense- but do we as patients want our care potentially influenced by financial incentives? That is why we got the “Sunshine Law” (technically it is called “The National Physician Payment Transparency Program: Open Payments”) through the Affordable Care Act.

Is marketing to build brand loyalty evil? Of course not.  Most industries have some sort of exchange occurring “to keep the client happy.” But most of us would be far less concerned about influence on our contractor to use a certain structural support in our home, than our doctor being incentivized to use a certain joint in our hip.

There just seems to be a difference when financial gain enters into medical care. As patients we want the medicine or medical device chosen because it is the best for us-not because it includes a bonus for whoever is holding the prescriptive pen.

I am not talking about criminal activity by the way– I am talking about the ubiquitous presence of the pharmaceutical and medical device industries in medicine. For decades they have literally been in most doctor’s waiting rooms- if not in the staff break area. The ACA it is not making any of that illegal- just transparent.

Starting in 2013 any exchange between a physician (or teaching hospital) and the pharmaceutical or medical device industries over $10 in value has been reported- and is now available on a public website. By physician name. With details.

Can a physician still think independently after having a chopped beef sandwich bought by an industry representative at lunch? Of course. Is a doctor accepting money from a pharmaceutical or medical device company necessarily wrong? Absolutely not.

There are, in fact, financial exchanges that are not only acceptable- but worthy. Oncologists committed to the cure for breast cancer may participate in scientifically sound, peer-reviewed medical research on a new chemotherapy agent- and the research is being funded by the company that makes the drug (not at all unusual in this day and age.) Is that illegal? Unethical? Of course not. But at the same time is it possible the patient would like to know about that connection? Yes. And it is her right to know.

Here is what physicians need to consider- can they explain a financial transaction with a pharmaceutical or medical device company to any patient without hesitation? Then it is not a problem. Public knowledge is not punishment and disclosure is not prohibition.

However- if they sat on an exotic beach, attended a professional sporting event, or savored a fine cut of steak through an industry representative, their patients will now know that too.  If disclosure of any activity makes a physician wince, it is probably time to stop.

By the way- this is not new. For decades there have been efforts to stop financial transactions between physicians and corporations with an interest in their prescriptive power.

Some states have prohibited gifts to doctors or any other ties between them and these interested industries- and that has become the standard for teaching hospitals and medical schools. The “Sunshine” provisions in the ACA were originally proposed as “The Sunshine Act” –  which failed to pass Congress in  2007 and again in 2008.

Even the pharmaceutical corporations themselves responded to these concerns(or publicity of those concerns) by updating their own code of conduct through their representative body (PhRMA) in 2008, and all along the independent non-profit “newsroom” ProPublica has published details about money paid to physicians by related industries as part of their marketing strategy.

So in the end the search for disclosure of financial connections may not be new- but achieving it at this level is big. The Sunshine offered through the ACA is the end of a long story- but it is a happy ending. We are finally bringing transparency to medicine. That is the kind of thing most patients will want to know- and most physicians will be happy to support.

What Does This Mean?

Medical Device: “medical device is an instrument, apparatus, implant, in vitro reagent, or similar or related article that is used to diagnose, prevent, or treat disease or other conditions, and does not achieve its purposes through chemical action within or on the body (which would make it a drug)… medical devices act by other means like physical, mechanical, or thermal means… Examples range from simple devices such as tongue depressors, medical thermometers, and disposable gloves to advanced devices such as … implants, and prostheses. The design of medical devices constitutes a major segment of the field of biomedical engineering.” Wikipedia

PhRMA: the Pharmaceutical Research and Manufacturers of America, represents the country’s leading biopharmaceutical researchers and biotechnology companies.