Let The Sunshine In!
A rare entry in the good policy column. I heard from Propublica and NPR yesterday that some major manufacturers of drugs have cut down the amount of money they spend paying doctors to speak about their products by half. These companies include Eli Lilly, Novartis, and Pfizer, among others. Now, this reduced spending is valued in the area of 15-20 million dollars per company, chump change for Big Pharma. Still, good progress, right? These companies are seeing the error of their ways…
Well, not quite. Big Pharma has had, for some time, a loose relationship with the truth and a very cozy one with some physicians. Ten big pharmaceutical companies have been fined a total of 13 billion dollars in the last few years for fraudulent marketing. Ten of them. Most of the fraud involved mislabeling drugs, failing to list side effects, and most often, marketing drugs for inappropriate or off-label uses. So the marketing problems have not been in relation to physician compensation per se. Since physician compensation for drug speeches comes under the label “marketing”, it’s hard to see how doctors could have been totally innocent in these cases.
But there might be another reason payment for doctors to do drug speeches and dinners is going down. The ACA. Obamacare. Yes, that hated piece of legislation. I know, health insurance exchanges and the problems therein have made the headlines, but did you know there’s a provision in the act called the Physician Payment Sunshine Act? No? There is. And guess what? It goes into effect this September. I love love love this act! If it works the way it’s supposed to. Here’s what I suspect: any pharma CEO worth his salt is going to look at his budget for marketing and simply move physician payment money to another, murkier, marketing strategy. And why? Does this CEO have something to hide? Something he doesn’t want the sun to shine upon? Otherwise, why the cut in spending? The pharma companies say the decrease is the result of an unusually large number of drugs going off-patent. Meh. Not totally buying it.
There is a big truck-sized hole in this sunshine act. Pharma does not have to report payments to NPs and PAs. I’m sure our CEO can find a way to work this. There is only one way to stop pharmaceutical companies from spending some of patient’s money to compensate doctors. Doctors have to say NO. NO, NO, NO. There is absolutely no reason doctors should be involving themselves in the marketing of any drug, I don’t care how fabulous or life-saving. That is not our job. It demeans our field, makes our patients mistrust us, and detracts from our ability to take care of people. Please, colleagues and friends. Just don’t.