Beginning in September 2013, we will have the right to know if our doctors are being wined, dined, gifted, funded, or in any way compensated by a pharmaceutical company, thanks to the Physician Payment Sunshine Act. There is evidently a lot of money changing hands, because the cost of recording all those payments and complying with the new federal law is going to be $224 million the first year, and $163 million annually thereafter. The purpose of the law is to ensure that undisclosed financial ties do not unduly influence medical research and medical practice.
A federal website will be maintained for the public, listing names of physicians and the value in dollars of payments received from manufacturers greater than $10 (add three or four zeros for some physicians). Doctors will also be required to disclose their stock holdings involving companies that supply drugs, medical devices and biologics. Aside from the extra cost to health care providers (which will likely be passed along to patients), this law is good news for consumers.
How do pharmaceutical companies feel about the bright light of day shining on the wined and dined? Pharma is apparently not too confident that we, the consumers of their goods, can handle this information. They are concerned that transparency “without context” could give us the wrong idea. They are worried that we might think drug companies are actually trying to buy influence by giving our doctors gifts, food, entertainment, travel, honoraria, research funding, grants, charitable contributions, direct compensation for teaching, consulting fees, investment interest, royalties, licensing fees and speaking fees.
Now why would we think that? John Castellani, President and CEO of the lobbying group Pharmaceutical Research and Manufacturers of America (PhRMA) tells us that “transparency should bring clarity, not confusion.” Ironically, this is how PhRMA describes its “transparency” to the Centers for Medicare and Medicaid Services:
“Our comments to CMS are long and complicated, reflecting the complexities of the issue. They make use of examples, hypotheticals and incredibly long descriptions.”
Such tactics do not bode well for either transparency or clarity. In fact, medical consumers may be left wondering if this is just another old-fashioned snow job. Pharmaceutical companies are very worried that the Physician Payment Sunshine provision of the Patient Protection Affordable Care Act will result in consumers looking at a physician’s name and a dollar amount the doctor is paid by companies that make drugs, medical devices or supplies, and draw conclusions without understanding “the information learned, the expertise provided, or the resources that went into the particular research work.”
The law is meant to provide the public with transparency “in interactions between biopharmaceutical companies and health care providers.” (Try wading through pages 1542 – 1563 of the Affordable Care Act.) But Castellani fears that patients will see “such limited information as inaccurately suggesting a physician’s bias, despite research that has shown that this could not be further from the truth.” Getting at “the truth,” however, is not what pharma-funded research is known for, as evidenced by drug safety studies in which the “placebo” is not inert, or the epidemiological study of a vaccine preservative whose data is repeatedly reworked until it can no longer be shown to cause developmental delay in children.
Castellani says pharmaceutical companies want “more useful transparency.” The Canary Party asks, useful to whom? He claims that “we’re proud of the way that we collaborate with physicians, and they with us, in the interests of medical progress. Our goal is to continue working with CMS to create a tool with the appropriate resources for patients to appreciate this, as well.”
Does that last sentence sound like doublespeak nonsense to you? It doesn’t make any sense to us either. Unfortunately, the people who wrote it have a seat at the table with the Centers for Medicare and Medicaid Services.
Let’s hope that table isn’t at the Four Seasons.