The drug industry’s main trade group, PhRMA, just announced that it will support a congressional bill that would publicly post all drug company payments to physicians. The bill, the Physician Payments Sunshine Act, was initially resisted by drug companies, but recently Eli Lilly announced its support of the legislation, and both Merck and AstraZeneca have followed suit. Given these developments, and given that the bill has substantial support in the House and Senate, it is virtually certain of passage.
What would this bill actually do, and what are the implications in terms of scaling down the extent of corruption in industry-supported medical education?
You can view The Prescription Project’s fact sheet on the bill here, and coverage of the latest developments from the excellent Politico website here. Essentially, the bill forces drug companies to report any payments or gifts to physicians, as long as they are valued at more than $500. This would include payments for speaking, consulting, travel reimbursement, and various other activities. Payments for clinical research and the value of drug samples would be exempt from disclosure requirements.
It's a great start, but unfortunately, the bill misses one of the largest sources of industry payments to physicians: payments to third party medical education communication companies (MECCs). This is the money laundering scheme used by industry to make drug advertising look like objective continuing medical education. A drug company awards a MECC an “unrestricted educational grant” for a conference on, say, antipsychotics. The MECC then hires physicians as faculty members who can be counted upon to say good things about the sponsor’s drug. The checks to these physicians are then nominally written by the MECC, although the drug company is the actual source of the money. These payments typically begin at $1000 and head skyward from there. And this doesn’t include additional thousands for reimbursement of lavish travel expenses. In 2006, drug companies funneled $1.2 billion into this sleazy shell game. In its current form, the Physician Payments Sunshine Act will allow these payments to go completely unreported, because it focuses only on direct financial transfers between drug companies and doctors.
On the positive side, all non-CME, explicitly “promotional” talks will be subject to the bill’s provisions. This means that patients will be able to look up their doctors on the Physician Payments website, and find out exactly how much money they accepted from which companies, to do what. I predict a rapid depleting of the speakers bureaus of drug companies, because most doctors will be too ashamed to have this information made public. Only the most mercenary of the hired guns will remain, and they will rapidly lose their credibility as their audience members connect the dots between their financial incentives and the promotional content of their talks.
But in what could well become a case study for the Freakonomics column in the New York Times, the bill actually creates strong financial incentives to further distort medical education, precisely the opposite of what is intended. This is because hired guns who do not want to be exposed will simply shift from promotional talks to CME talks, where the third party MECC umbrella will continue to hide them from the “sunshine” of the bill’s requirements. The drug companies will follow the speakers, and we will see commercial support of CME mushroom. Good news for the MECCs. Bad news for medical education.
Luckily, the bill’s language is still being tweaked, and I hear rumors that Senator Claire McCaskill, one of the co-sponsors, is pushing for inclusion of a provision requiring disclosure of CME payments.