Why would a doctor resist having payments made public? I put that question to Ben Goldacre,
physician and author, most recently, of Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.
Goldacre responded, "I think they're often embarrassed. That in itself is enough to tell you that this is something that needs to be in the open." In fact,
Goldacre observed, "academic research has repeatedly shown that doctors who receive money from industry have biased views about which treatment works
best."
Goldacre cited the diabetes drug Avandia as a good example of how obscured financial ties can harm patients. Avandia, Goldacre noted, "is now estimated to
have caused tens of thousands of heart attacks in the U.S. alone. Concerns had been raised for many years, and the academic literature was divided,"
meaning that the average doctor might reasonably have been confused from the medical literature as to what to think about the drug. In 2010, a careful analysis of the medical literature showed that, in Goldacre's words, "academics and doctors who
said heart attacks weren't a problem were over three times more likely to have received money from the pharmaceutical [industry], and from GSK [the
manufacturer] in particular."
Indeed, Howard Brody, a physician and ethicist at the University of Texas Medical
Branch-Galveston and author of
Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, suggested in an email interview that "the real goal of Sunshine legislation is to attack the total amount of influence that the pharmaceutical and device
industries exercise over medical research," and thus over practice that is based on that research.
Brody argued, "It is hard for a conscientious physician today to learn the truth about which drugs work and how safe they are, even if that physician only
reads medical journals and does not ever talk with drug sale reps," sent to their offices by drug makers, "since so many of the articles published in
reputable journals have distortions introduced by commercial sponsorship." The problem gets compounded, he said, when practicing physicians are pressured
"to adhere to clinical practice guidelines for treating common conditions, and the physicians who sit on those guideline panels often have serious
financial conflicts of interest with industry."
Although transparency about financial ties does not "cure" influence, it at least helps us understand it. There may, of course, be legitimate
reasons for a physician to be paid by a pharmaceutical company -- for example, for conducting a study -- but watchdogs like Angell, Goldacre, and Brody see
no reason why such relationships should be obscured.
While we've been waiting for the Sunshine Act to take effect, piecemeal efforts by non-profit institutions have already resulted in some windows of
transparency. The public interest journalism group Pro-Publica has been providing a "Dollars for Doctors" portal that allows users to search payments to individual physicians.
Some medical schools have also taken to requiring their faculty to disclose financial ties; for example, my medical school openly publishes who pays each of us -- although not how much.
The "Unbranded Doctor" campaign of the National Physicians Alliance has organized a pool
of physicians who, in Brody's words, "have taken a principled stance against commercial influence distorting medical practice."
