Doctors, drugs and disclosure

prescribing.jpg  These two articles were just published in JAMA and the Journal of Clinical Oncology [subscription required]:

Ross JS, Lackner JE, Lurie P, Gross CP, Wolfe S, Krumholz HM. Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota. JAMA 2007; 297(11):1216-1223.

CONTEXT: Recent legislation in 5 states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In 2 of these states, Vermont and Minnesota, payment disclosures are publicly available.
OBJECTIVES: To determine the accessibility and quality of the data available in Vermont and Minnesota and to describe the prevalence and magnitude of disclosed payments.
DESIGN AND SETTING: Cross-sectional analysis of publicly available data from July 1, 2002, through June 30, 2004, in Vermont and from January 1, 2002, through December 31, 2004, in Minnesota.
MAIN OUTCOME MEASURES: Accessibility and quality of disclosure data and the number, value, and type of payments of $100 or more to physicians.
RESULTS: Access to payment data required extensive negotiation with the Office of the Vermont Attorney General and manual photocopying of individual disclosure forms at Minnesota’s State Board of Pharmacy. In Vermont, 61% of payments were not released to the public because pharmaceutical companies designated them as trade secrets and 75% of publicly disclosed payments were missing information necessary to identify the recipient. In Minnesota, 25% of companies reported in each of the 3 years. In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2416 payments of $100 or more to physicians; total, $1.01 million; median payment, $177 (range, $100-$20,000). In Minnesota, among 6946 payments totaling $30.96 million publicly disclosed, there were 6238 payments of $100 or more to physicians; total, $22.39 million; median payment, $1000 (range, $100-$922,239). Physician-specific analyses were possible only in Minnesota, identifying 2388 distinct physicians who received payment of $100 or more; median number of payments received, 1 (range, 1-88) and the median amount received, $1000 (range, $100-$1,178,203).
CONCLUSIONS: The Vermont and Minnesota laws requiring disclosure of payments do not provide easy access to payment information for the public and are of limited quality once accessed. However, substantial numbers of payments of $100 or more were made to physicians by pharmaceutical companies.

Jagsi R. Conflicts of interest and the physician-patient relationship in the era of direct-to-patient advertising. J Clin Oncol 2007; 25(7):902-905.

Conclusion: The matter at the heart of all of the cases discussed in this article is the increasingly empowered consumer-patient’s desperate need for unbiased information. The proliferation of advertisements from parties with financial interest is particularly dangerous when the physician cannot serve in an unbiased intermediary role. As illustrated by the cases herein, these situations are far from uncommon. As a result, physicians owe their patients disclosure of potential conflicts of interest. In addition, physicians should avoid becoming entangled in the potential conflicts of interest created by direct gift relationships with industry and should advocate for restraint in DTC advertising when other conflicts of interest are particularly acute, as in the cases of ads for physician services or equipment with high capital costs in which physicians have an ownership interest. Efforts to improve the quality of information available to patients through advertising and other media must be accompanied by concomitant efforts on the part of the medical profession to improve the ways in which physicians communicate with their patients, not only about the medical issues themselves but also about the conflicts of interest that are an inherent part of every physician-patient relationship.

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