External threats ... and internal barriers
Public pressure for controlling conflicts of interest is growing. The national press reports regularly on the dangers and cost to patients of drug industry influence on physician decisions. Some states, including Vermont, Minnesota and Maine, have already passed laws limiting gifts to physicians or requiring public disclosure, while several Attorneys General have initiated or joined cases against potentially illegal relationships between pharmaceutical companies and physicians. (23-25) Washington, D.C. lawmakers are also considering action. Congressman Peter DeFazio (D-Ore) has introduced a bill requiring drug and device companies to disclose marketing and promotional gifts given to doctors. (26) Senator Chuck Grassley (R-IA) has introduced a similar measure, (27) and the Senate Finance Committee has begun investigating the extent of pharmaceutical industry influence over continuing medical education content. (28, 29) The Senate Aging Committee is also examining the influence of pharmaceutical industry marketing on medicine. (30)
Although some AMCs have begun to address these issues, the national landscape remains relatively unchanged. Through our discussions with AMC leaders, we have identified a number of barriers to moving ahead, and are developing strategies to counter them:
As more AMCs strengthen their guidelines, some of these barriers will disappear. Industry threats to withdraw funding from stringent AMCs will lose effectiveness, and fears of competition for faculty will weaken.
"The legislation requiring public disclosure of the financial relationships between healthcare vendors and physicians has been widely discussed in policy circles for years. Critics claimed payments for speaking, consulting, research or even the small trinkets and meals delivered during routine sales calls unduly influenced physician choices and inflated healthcare costs. To combat those effects, Congress required public reporting of those payments in a publicly accessible database. The legislation, labeled the Physician Payment Sunshine Act, was included in the 2010 healthcare reform law."
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Prescription project director Danny Carlat identifies issues with the Physician Payments Sunshine Act requiring further clarification and guidance. Addressing those would ensure that manufacturers can appropriately implement the final rule, and enable consumers to benefit from transparency reports published by the Centers for Medicare & Medicaid Services.
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The Pew Charitable Trusts is working to decrease the influence of pharmaceutical marketing on doctors’ practices. With a three-year grant from the Attorney General Consumer and Prescriber Education Grant Program, Pew is collaborating several partners to improve conflict-of-interest policies within the 158 medical schools and 400 major teaching hospitals in the United States.
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The Pew Charitable Trusts appreciates this opportunity to submit comments to CMS's "Information Collection Activities" draft guidance. We suggest that both the research and non-research payment templates be modified in order to make it easier for consumers to identify which drugs, devices, biologicals, or medical supplies are associated with particular transfers of value.
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On Feb. 1, 2013, the Centers for Medicare & Medicaid Services published the final rule guiding implementation of the Physician Payments Sunshine Act, which Congress passed as part of the Affordable Care Act in March 2010 to increase transparency in the relationships between physicians and drug and medical device makers. Here are some of the highlights.
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