Tuesday, January 13, 2009

Physician Disclosure Tipping Point

The public is increasingly demanding real disclosure of doctors’ ties to the pharmaceutical industry. Here is a run down of some recent events.

In Texas, two lawmakers have files disclosure bills that would require drug manufacturers to report all payments to Texas health-care providers – including consulting fees and honoraria, gifts and travel perks. The Texas Medical Association has already declared its support of the bill. Dr. Josie Williams, the association’s president, said her organization "supports transparency in health care, and favors transparency in this area as well."

In Wisconsin, the Milwaukee Journal Sentinel has published this remarkable two-part series by John Fauber spotlighting the activities of hired gun physicians in the state. Sifting through disclosure records of the University of Wisconsin-Madison, Fauber found that 114 university physicians had moonlighting jobs as hired guns for drug companies in 2007 and 2008.

Dr. Barry Fox, an infectious disease specialist, received particular scrutiny in the article. The Joseph Biederman of Wisconsin, Dr. Fox had side jobs with 7 different companies in 2007, including various speaking and consultation gigs. Among other drugs, Fox has promoted Avelox, and antibiotic that causes tendon ruptures and tendinitis in some patients. Did Fox discuss the dark side of Avelox in his talks to doctors? Fauber tried to find out the details of his stump speeches, but was stymied in his efforts:

Reached by phone in March, Fox initially agreed to listen to questions.
"I have nothing to hide," he said.
When asked what kind of work he did for a drug company, he said, "I'm not very comfortable with this conversation," and hung up. Several attempts to reach him since have been unsuccessful.

Dr. Robert Golden, the dean of the University of Wisconsin Medical School, is taking disclosure issues seriously:

[Golden] said an overhaul of the conflict-of-interest policy is being considered, including disclosing the actual amount paid by a drug or device company.
"We want to know if someone is getting $20,000 rather than $200,000," he said.
He said the change could be in place by April, when the disclosure forms must be filed.

In my home state of Massachusetts, hearings have been held to decide how to implement the gift ban and physician payment disclosure law passed last year. The Department of Public Health has made a preliminary judgment that physician payments for research need not be disclosed, but others disagree. You can find good coverage of one of the hearings in the Health Care for All blog

Drug Wonks’ arch conservative Peter Pitts has chimed into the debate with this op-ed in the Boston Globe
. As usual, Mr. Pitts, in arguing for less disclosure, neglected to disclose his own conflicts of interests. He designated himself "president of the Center for Medicine in the Public Interest and a former associate commissioner of the FDA." But as Dr. David Egilman pointed out in a comment, “he failed to mention that this is a front organization set up to represent the pharmaceutical manufacturers not the public's interests. He was too modest and forgot to mention that he was also "Senior Vice President for Health Affairs at Manning, Selvage & Lee.” Which is a PR firm representing drug companies.


Anonymous said...

Golden is a psychiatrist.

Bernard Carroll said...

Robert Golden is also singing a new tune. Back in 2006 he co-signed an ill advised letter to the Wall Street Journal defending the indefensible Charles Nemeroff's nondisclosure in the Cyberonics debacle. Do did Douglas Bremner.

Anonymous said...

Thanks for pointing that out. As for my signing the letter this has come up before on other sites so I have posted a response on my own site here:


This posts has links to other discussions of my research topics and disclosures previously posted on my site.

Anonymous said...

This week Robert Golden, dean of the University of Wisconsin medical school, made the following statements in the Milwaukee Journal Sentinel: "I am very bothered by our faculty using our school's name in giving non-academic promotional, marketing talks...It’s a major issue we are talking about now.” The discussion is likely to include the following items:

How do “non-academic promotional, marketing talks” and continuing medical education (CME) activities differ? What are hybrid CME/promotional activities?

Starting next month a University of Wisconsin faculty member will be traveling to other states to give talks, according to the itinerary posted here:

The activity is supported by drug companies. Who is paying travel expenses, and why? Would it not be more cost-effective and convenient for the state-paid university faculty to talk at the university hospital where he is employed? Why not help lower the cost of products and avoid worries about industry influence in CME altogether by refraining from asking drug companies to support CME activities?

Anonymous said...

Intriguing. I got a lot of good information from the Health care for all Blog. Thanks for the link & the information!

Anonymous said...


I think you'd increase your credibility if you avoided loaded, biased phrases like this:

"...physicians had moonlighting jobs as hired guns"

"The Joseph Biederman of Wisconsin, Dr. Fox had side jobs..."

Anonymous said...

I'm enjoying your blog, Doug. And I just realized you're the author of "Brain Imaging Handbook," which I read a few years and greatly enjoyed.

If only more mental health practitioners would read books like this.