Find Out If Your Doctor Takes Drug Company Money

The long-time editor of a prestigious medical journal started his editorial on physicians’ conflicts of interest describing a fantasy that doctors treat patients using simply the best evidence and experience, rather than being influenced by money or self interest. This is, of course, nonsense. There is a reason pharmaceutical companies spend billions of dollars on influencing, educating, and entertaining of doctors around the world.

The vast majority of physicians in the United States take gifts from the pharmaceutical industry, and, ironically, cardiologists, whose practice centers around diseases that can largely be prevented and treated with lifestyle changes, receive the most payments of all. A previous compilation of surveys from the 80s and 90s found that, on average, doctors met with drug industry representatives about once a week. Today, your family doctor meets with drug company employees 16 times a month. There’s only 20 workdays a month, so that’s nearly every day.

What does the public think about this? Only about half even appear to know what’s going on. So, if 83% of doctors receive gifts, it is likely that a significant percentage of patients are not aware that their personal physician receives industry gifts. And, we’re talking more than just a Viagra paperweight or soap dispenser. For marketing, pharmaceutical companies spend $15,000 per physician every year, making conflicts of interest one of the most pressing problems in American health care.

How do doctors feel about it? Most generally approve of the gifts; however, tellingly, physicians do not want gift relationships made public. Physicians do not agree that it is inappropriate to accept gifts, but their reluctance to disclose the gift relationship to the public suggests that they must recognize that the public would not appreciate the practice. To analyze how physicians resolve this contradiction, researchers conducted a series of physician focus groups. It turns out physicians used a variety of denials and rationalizations; they avoided thinking about it, denied responsibility… Physicians readily acknowledged the inherent conflict of interest, but this didn’t stop them. In fact, some complained that the gifts were getting more modest. We tend to deny that we personally have any conflict of interest if a pharmaceutical company buys us a nice dinner. We tend to insist that it won’t affect our judgment in any way, as if drug companies just like wasting money on purpose. Most physicians contend that their colleagues are susceptible to the industry’s influence, but not them.

Though physicians don’t want these gift relationships to be public, that’s just too bad, because, thanks to Republican Senator Chuck Grassley, the Sunshine Act was inserted into Obamacare. And, so, for the first time, patients will now be able to see what, if any, financial ties their own doctor has. Doctors can’t hide anymore. This will give patients some insights when choosing a provider, and once the database goes live, law enforcement agencies can also investigate kickback cases to see who’s getting money from industry. Right now, it might just be embarrassing, but this could allow attorneys general to go after doctors to see the kinds of incentives they may be getting for writing a lot of prescriptions. And, the database is live right now. Go to openpaymentsdata.cms.gov/search or for a more user-friendly version, Propublica’s Dollars for Docs page. The drug industry spends billions trying to influence doctors, and, for the first time, you can see if your physician, or any physician, has their hand out.

Senator Grassley hoped this would help save our nation money. It could reduce healthcare costs if patients view such doctors as less trustworthy, and choose doctors less in bed with industry or could change physician behavior. They may want to avoid financial relationships with companies to guard against this patient distrust or becoming the target of an exposé or investigation. Or, they could just try to cover it up. This is from the American Academy of Family Physicians, advising physicians how to avoid getting burned by the Sunshine Act. For example, drug companies now have to report when they give doctors free meals valued at over $10. So, should family physicians just stop accepting free food from drug companies? No way—you just have to give the drug sales reps the right head count, so the meal cost dips below $10 per person.

The former long-time editor of the New England Journal of Medicine said it best: although the spotlight has been on disclosing doctors’ financial relationships with industry, the problem with conflicts of interest is not the lack of disclosure but the existence of the conflict itself. Rather than just disclosing them, the best approach to financial conflicts is to have none.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

• L. Rosenbaum. Conflicts of interest: part 1: Reconnecting the dots--reinterpreting industry-physician relations. N Engl J Med. 2015 May 7;372(19):1860-4.
• P R Lichter. Implications of the Sunshine Act--revelations, loopholes, and impact. Ophthalmology. 2015 Apr;122(4):653-5.
• T Rowe. Less than the truth. J Obstet Gynaecol Can. 2013 Nov;35(11):971-4.
• D Grande, J A Shea, K Armstrong. Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system. J Gen Intern Med. 2012 Mar;27(3):274-9.
• E Silverman. Everything you need to know about the Sunshine Act. BMJ. 2013 Jul 26;347:f4704.
• E G Campbell, R L Gruen, J Mountford, L G Miller, P D Cleary, D Blumenthal. A national survey of physician-industry relationships. N Engl J Med. 2007 Apr 26;356(17):1742-50.
• A Ritchie. Sunshine Act to add more transparency to physician income. Med Econ. 2014 Jan 10;91(1):57.
• P Hurd. The Sunshine Act: how to avoid getting burned. Fam Pract Manag. 2013 Sep-Oct;20(5):8-10.
• K Abbasi, R Smith. No more free lunches. BMJ. 2003 May 31;326(7400):1155-6. 
• J P Kassirer. Commentary: Disclosure's failings: what is the alternative? Acad Med. 2009 Sep;84(9):1180-1. 
• S Chimonas, T A Brennan, D J Rothman. Physicians and drug representatives: exploring the dynamics of the relationship. J Gen Intern Med. 2007 Feb;22(2):184-90. 
• R Smith. Conflicts of interest: how money clouds objectivity. J R Soc Med. 2006 Jun;99(6):292-7.
• S Madhavan, M M Amonkar, D Elliott, K Burke, P Gore. The gift relationship between pharmaceutical companies and physicians: an exploratory survey of physicians. J Clin Pharm Ther. 1997 Jun;22(3):207-15.
• S Agrawal, N Brennan, P Budetti. The Sunshine Act--effects on physicians. N Engl J Med. 2013 May 30;368(22):2054-7. 
• Rosenthal MB1, Mello MM. Sunlight as disinfectant--new rules on disclosure of industry payments to physicians. N Engl J Med. 2013 May 30;368(22):2052-4.
• A Wazana. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000 Jan 19;283(3):373-80.

• industry influence
• medical education
• medical profession
• medications
• weight loss