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In the U.S., the Open Payments database lays out pharma's payments to doctors for all to see. In Germany, where disclosure isn't mandated as it is in the U.S., a nonprofit is trying transparency based on the honor system. German doctors will be able to voluntarily disclose contributions from pharma in a database compiled by the nonprofit journalism organization Correctiv, according to Germany’s DW. About 71,000 doctors in the country received €575 million in cash or in-kind contributions from the drug industry last year, a Correctiv investigation found in December. That's far less than the $7.52 billion that drug and device makers funneled to doctors and healthcare providers in the U.S. in 2015, the most recent data available, but slightly more than the £345 million that changed hands in the U.K. (read “Sun Rises on UK Pharma Payments to HCPs”; http://sco.lt/5MQJqD) Making those payments public at the doctor-by-doctor level is important, advocates say, because studies show financial relationships between drugmakers and doctors can affect physicians' prescribing habits. Unlike in the U.S., German or European law doesn’t require docs to disclose industry contributions. Correctiv and Spiegel Online found that only 29% of doctors in the country were willing to have their pharma payment info published as of the December report. Correctiv is now making that voluntarily reported data public. Further Reading: - “Surprise! #Pharma $ to Docs Continue Virtually Unabated Despite Sunshine Law”; http://sco.lt/6wERKj
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The financial relationships between nearly 1,500 drug and device companies and 619,000 doctors, as well as teaching hospitals, are now disclosed publicly under a provision in the Affordable Care Act. Drug companies have long maintained that the relationships assist in drug development and education, while critics argue the payments skew physicians’ prescribing and research decisions. Despite the increased scrutiny, payments to Connecticut doctors [as an example] declined only slightly in the last two years — from $28.3 million in 2014 to $24.9 million in 2015. Nationally, the total paid to physicians also remained relatively steady: $3.7 billion in non-research payments in 2014 and $3.63 billion in 2015. In Connecticut, more than half of all payments went to physicians in two specialties: internal medicine ($10.9 million) and orthopedic surgery ($3 million). Psychiatrists and neurologists followed, with $2.5 million in payments. Companies that paid the most to Connecticut doctors were AbbVie, Arthrex, AstraZeneca and Pfizer, each of which spent more than $850,000 in Connecticut. Nationally, two of those drug makers — Pfizer and AstraZeneca — were among the top 10 highest-paying companies. Novartis Pharmaceuticals topped the national list, with $539 million in payments, followed by Genentech at $470 million and Pfizer at $436 million. Dr. Joseph Ross, an assistant professor of medicine at the Yale School of Medicine who has written about the industry’s influence on physicians, said he was surprised that the 2015 payments, nationally and in Connecticut, had not declined.
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Over 80% of doctors and other healthcare professionals who received payments or benefits in kind from Novartis disclosed their data publically in 2015. Novartis is proud of its collaborations. Working together with the NHS, its staff and patient groups is vital for improving outcomes for patients and ensuring they receive the best possible care. Patients benefit from these collaborations with new and improved medicines, better services and care, and clinical teams that have benefited from education. The disclosure of payments to individuals is an industry-led initiative, which Novartis fully supports and has fully complied with by providing the Association of British Pharmaceutical Industries (ABPI) with a list of payments to be published on their common platform, where all pharmaceutical company payments to individuals and healthcare organisations in the UK are listed. Transparency across the public sector, including healthcare, is increasingly being demanded by the general public. Novartis has made every effort to encourage all individuals to disclose details of their payments, and is committed to continuing working with all stakeholders to increase transparency around these relationships. We believe that open communication about these interactions helps foster trust with patients, the NHS, and the public, and we are dedicated to full transparency. We are committed to working with integrity, upholding high ethical standards, and following all laws and regulations.
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This week the Association of the British Pharmaceutical Industry (ABPI) launched its long awaited database of payments to doctors. This is a useful step towards greater transparency and public accountability, but it serves mainly to show just how far we have yet to go.
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[Curated by @pharmaguy; image copyright 2016, Pharma Marketing Network.] UK pharma has published details of the payments and benefits in kind it provides to doctors, nurses and pharmacists as long-awaited industry transparency rules come into force.
The ABPI's publically-available database, Disclosure UK, reveals the industry paid healthcare professionals (HCPs) £340.3m in 2015, two-thirds of which (£229.3m) was for R&D work.
The remaining £111m was for a range of commercial rather than R&D activities, with nearly half of that money (£49.3m) going on a range of service and consultancy fees.
The next largest chunk of money was for event-related payments, which accounted for £31.4m in 2015, with £10.8m of that going on travel and accommodation.
Closely behind that were donations and grants to healthcare organisations, on which UK pharma companies spent £30.3m in 2015.
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The following discussion was commissioned and controlled [LOL!] by the Guardian, funded by ABPI. Virginia Acha, executive director, research, medical and innovation, ABPI: I trust my GP to be able to hear all of the comments and all of the information, and make a decision in my best interests. The main thing is to support that exploration of all of the facts and in a transparent way. Dr Peter Gordon, campaigner for transparency in medicine: Science strives to be objective. Partnership with commercial interests risks putting the shareholders first. Jeremy Taylor, chief executive, National Voices: The question is at what point health professionals would become embarrassed into disclosure. Suppose patients started using presence on the register as a criterion for choosing some professionals over others? [For more on that, read "“Patients May Leave Docs Who Prescribe Expensive Drugs & Take $ from #Pharma”; http://sco.lt/5RtFk9] Gordon: The significant majority of healthcare workers, scientists and academics have never received payments from outside commercial interests. My worry is those that do – the key opinion leaders ... need not declare. Dr Waheed Jamal, vice president – medical, Europe, GlaxoSmithKline: We have what we call a “no consent-no contract” policy to help make sure there is close to 100% individual-named disclosure in line with the EFPIA [European Federation of Pharmaceutical Industries and Associations]/ABPI code. This means we will no longer work with healthcare professionals in future should they not give consent to disclose the payments that have been made. David Eves, head of compliance, Chugai Pharma Marketing Ltd: The pros are that the development of any therapy will be more meaningful and add value to patient care in the UK. Without that interaction the decisions made regarding where a product may fit will hold less value. Acha: I think the focus so far is on payments to healthcare professionals for their advice and work on specific projects (eg pre- and post-licensing advisory boards). Actually, a good share ... is related to supporting healthcare professionals to attend international congresses and other continuing medical education. This is vital to ensure that our healthcare professionals remain at the forefront of scientific debate. This helps everyone.
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In a poll of more than 500 UK healthcare workers carried out for the Association of the British Pharmaceutical Industry, 87 percent believe payments from pharma companies to individually named healthcare professionals should be transparent, with around two thirds (64 percent) saying that this information should be publicly declared. However, a significant chunk - 26 percent - felt disclosure of payments to individually named HCPs is unnecessary, and 24 percent feared the move would adversely affect medical innovation, while 26 percent also felt their relationships with pharma companies would change as a result. The ABPI is just weeks away from publishing details of payments and benefits in kind made to UK HCPs and healthcare organisations on an online, publicly searchable database under its drive to improve transparency and trust in the industry. Nevertheless, while being largely supportive of the move, 69 percent of respondents did express concerns about the process. The biggest concern is potential misrepresentation of data (49 percent), closely followed by possible negative perceptions among the public (44 percent), data protection (43 percent) and potential media coverage (35 percent).
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A ProPublica analysis has found for the first time that doctors who receive payments from the medical industry do indeed tend to prescribe drugs differently than their colleagues who don’t. And the more money they receive, on average, the more brand-name medications they prescribe. **************** Nationally, about three quarters of doctors across five common medical specialties received at least one payment from a company in 2014. In Nevada, that number was over 90 percent. In Vermont, it was less than 24 percent. Note: The five specialties are family medicine, internal medicine, cardiovascular disease, psychiatry and ophthalmology. ***************** We matched records on payments from pharmaceutical and medical device makers in 2014 with corresponding data on doctors’ medication choices in Medicare’s prescription drug program. (You can read our methodology here.) Doctors who got money from drug and device makers—even just a meal– prescribed a higher percentage of brand-name drugs overall than doctors who didn’t, our analysis showed. Indeed, doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty. Doctors who received more than $5,000 from companies in 2014 typically had the highest brand-name prescribing percentages. Among internists who received no payments, for example, the average brand-name prescribing rate was about 20 percent, compared to about 30 percent for those who received more than $5,000. ProPublica’s analysis doesn’t prove industry payments sway doctors to prescribe particular drugs, or even a particular company’s drugs. Rather, it shows that payments are associated with an approach to prescribing that, writ large, benefits drug companies’ bottom line.
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The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest. The announcement appears to be a first for a major drug company — although others may be considering similar moves — and it comes at a particularly sensitive time for Glaxo. It is the subject of a bribery investigation in China, where authorities contend the company funneled illegal payments to doctors and government officials in an effort to lift drug sales. Andrew Witty, Glaxo’s chief executive, said in a telephone interview Monday that its proposed changes were unrelated to the investigation in China, and were part of a yearslong effort “to try and make sure we stay in step with how the world is changing,” he said. “We keep asking ourselves, are there different ways, more effective ways of operating than perhaps the ways we as an industry have been operating over the last 30, 40 years?”
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A bill proposed Wednesday by two U.S. senators would require drugmakers and medical device manufacturers to publicly disclose their payments to nurse practitioners and physician assistants for promotional talks, consulting, meals and other interactions.
The legislation would close a loophole in the Physician Payment Sunshine Act, which requires companies to report such payments to doctors, dentists, chiropractors, optometrists and podiatrists. Companies have so far released more than 15 million payment records, covering August 2013 to December 2014.
As ProPublica and NPR reported in July, the 2010 law doesn't include nurses with advanced degrees or physician assistants, even though they, too, can prescribe medications. Some have gotten in trouble for accepting kickbacks.
The bill, introduced by Sen. Charles Grassley, R-Iowa, and Sen. Richard Blumenthal, D-Conn., would expand the disclosure requirement beginning in 2017 to include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives.
"We think that the void should be filled in order to have a complete record," Grassley said in an interview. "Transparency isn't an end to itself. Transparency is meant to bring accountability."
Because the data aren't publicly reported, it's unknown how much money these professionals receive from makers of drugs and medical devices, or whether that figure has increased since disclosure of payments to doctors was required. But in recent years, a few nondoctors have been criminally charged with taking kickbacks from industry.
A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 from Insys Therapeutics in exchange for prescribing its high-priced medication Subsys to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.
And in 2012, a physician assistant in Rhode Island was sentenced to six months in prison and six months of home confinement after pleading guilty to taking kickbacks from a medical device company. The company paid him $50 to $300 for each bone growth stimulator ordered by the surgeon he worked for — all told, some $120,000 between 2004 and 2011. The company, Orthofix, and several of its officials also pleaded guilty to charges including fraud, obstruction, kickbacks or perjury.
Blumenthal, the new bill's co-sponsor, said the Connecticut case was "a clear, loud alarm bell."
"Doctors need to be held accountable, but so do all the other providers," he said. "Requiring these companies to disclose gifts and payments made to other health care providers, not just doctors, is absolutely necessary in today's world."
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The mutual relationship between physicians in academic medicine and the pharmaceutical industry has suffered substantially over the last decade.
Unfortunately, this mutual relationship has suffered substantially over the last decade due to, of all things, free lunches and pens! The pharmaceutical industry has been portrayed as using unethical techniques to promote unneeded medications.
This conflict has created a void in education regarding new medications. Academic leaders who called for the virtual banishment of pharmaceutical representatives from academic hospitals did not develop a plan to educate house staff and faculty about new medications. Our previous system, whereby house staff arrived early at a symposium for a modest lunch provided gratis by pharmaceutical companies to hear about new medications for the first 5 minutes, in the presence of their faculty, has been replaced by house staff and faculty busily scurrying to get food, showing up 10–15 minutes late for the lecture, and coming away with little information about new medicines.
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New data on drug and device company payments to doctors largely excludes nurse practitioners and physician assistants, though they play an ever-larger role in health care. One advanced-practice nurse pleaded guilty last month to taking drug company kickbacks.
the federal Physician Payment Sunshine Act doesn’t require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states.
Nurse practitioners and physician assistants are playing an ever-larger role in the health care system. While registered and licensed practice nurses are not authorized to write prescriptions, those with additional training and advanced degrees often can.
A ProPublica analysis of prescribing patterns in Medicare’s prescription drug program, known as Part D, shows that these two groups of providers wrote about 10 percent of the nearly 1.4 billion prescriptions in the program in 2013. They wrote 15 percent of all prescriptions nationwide (not only Medicare) in the first five months of the year, according to IMS Health, a health information company.
For some drugs, including narcotic controlled substances, nurse practitioners and physician assistants are among the top prescribers.
“Nurse practitioners see patients, order tests, recommend procedures and prescribe medications,” Dr. Walid Gellad, an associate professor of medicine at the University of Pittsburgh and co-director of its Center for Pharmaceutical Policy and Prescribing, wrote in an email. “It seems straightforward to think that their relationships with the pharmaceutical and device industries are of as much relevance as physicians, dentists, chiropractors, etc.”
He added, “If the purpose of the act is to shine a light on the relationship between industry and the health care sector, then you’ve left out an important component of that sector.”
Elissa Ladd, an associate professor of nursing at the MGH Institute of Health Professions in Boston, surveyed 263 nurse practitioners several years ago about their interactions with the pharmaceutical industry. Her survey, published in 2010 in the American Journal of Managed Care, found that nearly all had regular contact with drug company sales representatives. Nine in 10 believed that it was acceptable to attend lunch and dinner events sponsored by the industry.
Ladd said she supports mandatory disclosure of payments for nurse practitioners and physician assistants.
“Nurse practitioners think that they’re somewhat immune to this but I think that we’re no different than any other provider,” she said. “If nurse practitioners were reported on, I think that would be a huge concern for them. I don’t think they want to be perceived in a negative light.”
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On September 30, 2014, CMS published data records containing 4.4 million payments valued at nearly $3.5 billion in payments and transfers of value made to physicians and teaching hospitals in the last five months of Calendar Year 2013. This includes ownership or investment interests in applicable manufacturers and GPOs held by physicians or their immediate members, in addition to payments provided for research activities, gifts, speaking fees, meals, or travel.
These and other data are available to peruse using the "Data Explorer" tool on the OpenPaymentsData.CMS.gov website.
I recently used this tool to find out more about the types of payments big pharma companies make to physicians. I only looked at payments for items/services unrelated to research and ownership of stock; i.e., marketing-related items/services, which include
- Food and Beverage
- Consulting
- Charitable Contributions
- Education
- Grants
- Honoraria
- Speaker Fees
- Travel and Lodging
Unfortunately, I could not download the entire database because the number of records exceeds Excel's limit. Instead, I downloaded data for six specific pharma companies to perform my analysis. Although the result may not be representative of the entire drug industry, it does show how different companies dole out the dough to docs.
*The six companies I chose for my analysis include several with the highest yearly global sales. More... http://bit.ly/1Ee3uzv
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A NEW INVESTIGATION has revealed the extent of the financial relationship between the pharmaceutical industry and doctors and hospitals in Ireland.
A new special investigative report by the Sunday Business Post has shown the huge sums of money that pass between Big Pharma companies and hospitals and doctors in Ireland.
The report found that drug companies pay in excess of €17 million per year to Irish doctors, hospitals and healthcare companies.
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To keep doctors current on medical issues, drug makers help pay for continuing education. Until now, though, industry has not had to report the value of these sessions to a federal database created in response to mounting concerns that such payments may unduly influence medical research or practice. That is expected to change next year, however, when a new reporting requirement kicks in. And many physicians are pushing back. Already sensitive about financial disclosures about meals and research grants, many doctors are backing a Senate bill to exempt drug and device makers from reporting the value of continuing education, journal reprints, and textbooks provided to physicians. They argue that patients will lose out if companies choose to curtail their financial support when the reporting requirement goes into effect next year. [Fore more on that, read “AMA & Many Other Physician Groups Lobby to Keep CME Payments Out of the Sunshine”; http://sco.lt/9KptUv] “This bill will move us backwards, not forwards in seeking greater transparency in science,” said Paul Thacker, a former US Senate Finance Committee investigator who probed financial ties between industry and physicians and helped craft the law that created the database. “This initiative smells of money coming from industry to prop up biased continuing medical education and industry-supported studies that serve to market drugs to doctors.” As it so happens, health professionals were the largest financial contributors to Barrasso over the last five years, while the pharmaceutical industry was his third-largest financial supporter, according to the Center for Responsive Politics. Will companies cut back on such support because of another reporting requirement? It’s true drug makers and continuing education providers will have more paperwork, because industry support for continuing education is not paid directly to doctors. Instead, values will have to be assigned. The purpose of the database is to provide transparency. Carving out exceptions only keeps information behind a curtain.
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Nearly 100 national and state medical societies from around the United States are backing a Senate bill (see “21st Century Cures: Hide CME Payments & Allow Off-Label Promotion”; http://sco.lt/62vgQr) that would exempt drug and device makers from reporting payments made to doctors for receiving continuing medical education, or CME, sessions, medical journals, or textbooks. Among them are the American Medical Association and the American College of Cardiology. The move is the latest push in a long-running effort to roll back requirements for reporting such payments to a federal database, which tracks financial relationships between companies and physicians. Known as OpenPayments, the database was launched in 2014 in response to concerns that financial ties between drug firms and device makers and doctors may unduly influence medical practice and research. It was included in the Sunshine Act provision in the Affordable Care Act. A recent analysis found that payments can affect prescription rates. But more than once over the past few years, the Centers for Medicare and Medicaid Services, which maintains the database, appeared to change its mind on reporting requirements for CME payments, in particular. These payments are made by manufacturers or group purchasing organizations to CME providers, which are either commercial firms or nonprofits that organize courses for physicians. CME has been a particularly controversial issue, with accusations that drug and device companies not only fund the courses but they also tightly control the educational curriculum. Last year, industry support for CME totaled $693 million, a 2 percent rise, from the previous year, according to the latest report from the Accreditation Council for Continuing Medical Education, which regulates CME activities. In late 2014, CMS ultimately decided that reporting CME payments would be required. As far as the agency is concerned, medical information — whether in the form of courses, journals, or textbooks — has value that physicians would otherwise have to pay for themselves. However, the CMS decision prompted a lobbying push by industry and medical societies to eliminate the reporting requirement. The support from the medical societies for the bill, which is called the Protect Continuing Physician Education and Patient Care Act, is hardly surprising. In a letter to US Senator John Barrasso, a Wyoming Republican and a physician who introduced the bill, the medical groups argue, however, that Congress initially intended to create such exemptions and CMS may hurt medical practice. “Passage of this bill is urgently needed to remedy onerous and burdensome reporting obligations imposed by CMS that have already chilled the dissemination of medical textbooks and peer-reviewed medical reprints and journals, and to avert a similar negative impact on access to independent” CME, they wrote to Barrasso in a June 30 letter. “When a company gives a grant to an accredited CME provider, it’s pretty hands off. They’re not supposed to suggest speakers or influence the curriculum, for instance,” said Thomas Sullivan, president of Rockpointe. “So if a company that supports commercial CE has no control (over the use of its grant dollars), I don’t see why that should be reported. Doctors don’t have the direct relationship with the company.” “It’s a stretch to view free textbook and free medical education as being anything other than a benefit to physicians,” said Daniel Carlat, who runs a company that publishes CME newsletters for mental health practitioners. “These are not direct benefits to patients. The only way these would benefit patients is if a drug company gave free books or courses to patients themselves.”
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I stand up for the rights of pharmaceutical companies to buy lunches or host dinners that are educational in nature. Academics, reporters, and politicians who fear this practice is driving up the costs of health care need to calm down and think differently. As a pharmacist, I’ve gotten to know many pharmaceutical representatives over a sandwich. We talk about health care, drugs, side effects, and how to help patients. Those conversations are valuable to me, and I don’t mind the sandwich.
Here are 7 reasons to relax about the free pharma lunch:
1. Most health care providers work long hours and don’t have much availability in their day-to-day schedules. Many are on call nights, holidays, and weekends. In spite of this, they have to remain on the cutting edge of medical science, including knowledge about new drugs. Therefore, it’s simply efficient to combine learning opportunities with meals.
2. A health care provider’s time is extremely valuable. Every provider is needed at virtually all times. It’s all hands on deck every day to care for patients and save or improve lives. As such, every minute spent “working” is important and valuable. A relatively inexpensive meal in exchange for 15 to 20 minutes of time is a bargain.
3. The fact that prescribing frequency increases after engaging in lunch-and-learn sessions doesn’t mean that physicians wrote prescriptions out of guilt because they were given a free tuna fish sandwich, as they could afford their own lunch quite easily. The prescribing frequency could just as easily be tied to the education.
4. Providing a meal is a socially acceptable means for showing kindness and respect. If I want to thank you for your time, I might bake you a cake or cook you a casserole. You came over and fixed my computer? You’re getting a pizza. Sales representatives are responsible for educating prescribers in their territory through face-to-face meetings. A meal represents a tangible token of appreciation for their time.
5. Patients benefit when health care providers develop relationships with pharmaceutical companies. Many of these companies offer educational resources to patients and financial assistance to the uninsured or underinsured. But, getting these benefits to patients typically requires building relationships with providers. As a pharmacist, I can say I’m very grateful for some of the outstanding sales representatives I’ve gotten to know, because the services their companies offer are useful to my patients. Sometimes, these relationships have been built over a burger. Is that a crime?
6. Yes, it’s possible for incentives to go too far, but we’re talking about $18 to $20 meals, not lavish trips to the Swiss Alps.
7. Health care providers aren’t computers or machines. Learning takes time, and reminders about how a drug fits into the current recommended treatment regimen is appreciated. A drug representative gets to be an expert on a particular molecule, but we have to know all the molecules. So, spending a few moments with an expert on 1 specific drug helps reinforce best practices and treatment standards.
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The Truth In Media Project has released Part 3 of its latest series Truth In Media: Big Pharma, The FDA & Health Propaganda. Part 3, titled How Big Pharma Manipulates Physicians and Corrupts “Best Practices,” discusses how companies in the pharmaceutical industry influence doctors’ “best practices” as well as offer funding for research and court physicians and their staff in hopes of gaining loyalty. Devon Beasley, a registered nurse, has spent years in her field and told Truth In Media that she has seen representatives for pharmaceutical companies “wine and dine” an entire medical office in the midst of promoting various products. “Some of the offices that I would apply for would actually tell me ‘hey, we have catered lunches three times a week.’ That’s directly from pharmaceuticals. You also get materials for your office that make your office look really great,” said Beasley. “They will bring in supplies that make your office look like you have a lot of money.” Beasley went on to say that medication samples, which are common in the doctors’ office and part of the pharmaceutical companies’ strategy to promote certain products, are highly sought after by patients and can conflict with the pursuit of proper medical care. “No one is asking which is the safest medication, which is the best for me, which is best for the patient. It’s all about ‘do you have samples, do you have coupons? Can you prescribe me something that does have a coupon? Can you prescribe me something that does have a sample?’ And it has nothing to do with which one is best, most effective or safest,” said Beasley. Truth In Media’s Ben Swann also discussed the pharmaceutical industry’s impact on the medical community’s procedures known as “best practice,” which is the name for a system of policies that have been agreed upon by doctors and regulatory agencies such as the FDA. Swann explained that “the problem with best practices is how it is manipulated by big pharma. Research that best practice is based on is heavily funded by big pharma.”
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A higher percentage of doctors affiliated with hospitals in the South have received such payments than doctors in other regions of the country, ProPublica analysis shows. And a greater share of doctors at for-profit hospitals have taken them than at nonprofit and government facilities. As might be expected, hospitals with tougher rules, such as banning industry reps from walking their halls and bringing lunch, tended to have lower payments rates. For example, at Kaiser Permanente, a giant California-based health insurer that runs 38 hospitals, fewer than 3 in 10 doctors took a payment in 2014. Since 2004, the system has banned staff from taking anything of value from a vendor. "Our intent was to disrupt the strategy of using what industry calls 'food, friendship and flattery' to develop relationships with prescribers and influence the choice of drugs, the choice of devices, implants, things like that," said Dr. Sharon Levine, an executive vice president of the Permanente Federation, which represents the doctor arm of Kaiser Permanente. "Passing a policy alone doesn't make anything happen. There's a fair amount of surround-sound in the organization around reminding people about this and reminding them why we took this step." ProPublica's analysis found distinct regional differences in comparing where industry payments were most concentrated. After New Jersey, the states with the highest rates of hospital-affiliated doctors taking payments were all in the South: Louisiana, Mississippi, Florida, South Carolina and Alabama had rates above 76 percent. At the other end of the spectrum, Vermont had the lowest rate of industry interactions (19 percent), followed by Minnesota (30 percent). Maine, Wisconsin and Massachusetts had rates below 46 percent. Some of these states had laws requiring public disclosure of payments to doctors that predated the federal government's. There were also major differences between hospitals based upon who owned them. For-profit hospitals had the highest rate of payments to doctors, 75 percent, followed by nonprofit hospitals at 66 percent. Federally owned hospitals had the lowest rates at 29 percent, followed by other government hospitals at 61 percent. Hospitals operated by the U.S. Department of Veterans Affairs weren't included in our analysis. ProPublica found differences in the payment rates at teaching hospitals based on the grades assigned to them by the American Medical Student Association, which reviewed their conflict-of-interest policies in 2014. At the A hospitals we analyzed, 46 percent of doctors took a payment, compared to 48 percent at B hospitals, 58 percent at C hospitals and 63 percent at hospitals rated as incomplete because their policies were "insufficient for evaluation." By comparison, 69 percent of doctors at unrated hospitals took payments. Of the 204 hospitals graded, about 150 were in ProPublica's data (hospitals run by the U.S. Department of Veterans Affairs were not). "I think that's significant," said Thibert, the group's president. "That's still a lot of docs receiving money unfortunately. That's something we're continuing to work on."
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Pharmaceutical firms currently pay about £40m every year to healthcare professionals, including doctors and pharmacists. These payments could be for anything from expert advice to sponsoring a healthcare professional’s medical education. Now, the Association of the British Pharmaceutical Industry (ABPI) has created a central database, going live in June, on which its member companies, and others that have signed up to comply with the ABPI code of practice, will disclose who these payments are made to, and for what. [For comparison, pharma has made over $6 Bn in payments to physicians in the U.S. in 2014. $3.2 Bn of that was for research – see chart above.] How will this new transparency affect the complex matrix of relationships between health professionals, pharmaceutical firms, the NHS and, most importantly, patients? That was the underlying question under discussion at a seminar hosted by the Guardian and sponsored by the ABPI. Sarah Boseley of the Guardian kicked off the discussion by pointing out that the ABPI database has already come in for some criticism: the Academy of Royal Medical Colleges says it doesn’t go far enough. But should disclosure be mandatory? Only 69% of healthcare professionals say they would agree to have their relationships with pharmaceutical companies disclosed on the publicly searchable database. Ash Soni of the Royal Pharmaceutical Society agreed that disclosed payments need to be seen in the right context to be of value. “It’s important that there is an ability to respond and react to some of this disclosure.” The panel members were in broad agreement that increased transparency is a good thing, whether it’s disclosing payments or publishing clinical research data – but, like Soni, Nikki Yates of GlaxoSmithKline (GSK) stressed the need for education around its issues. “The way I’ve embraced it [disclosure and transparency issues] is to take a step towards ensuring that whoever we are working with has a full understanding of why this is an important thing to do,” said Yates. Since 2014, she said, GSK has had a disclosure clause in its contracts. Thus far, it has had more than 90% agreement for disclosure of trial results. “And we’ve gone a bit further and said if we can’t agree on disclosure, then we won’t work with those individuals.” [GSK has pledged that it will no longer pay doctors to promote its products. For more on that, read “GSK ‘Sunshine Blocks’ Outside Docs: No More $ For You!”; http://sco.lt/5ByCdV] But GP Dr Margaret McCartney pointed out that talking about shared goals, partnership and collaboration is all very well – but what are the shared goals and who decides what they are? She cited the pharmaceutical researcher who had approached her practice to do clinical research. When McCartney asked him if results would be published no matter what they showed, she was told no, and that McCartney herself would not be allowed to make them public. “How can I trust a leadership that says it will not guarantee published results, no matter what they show?” she asked. So should disclosure be required by law? McCartney said she was pleased with GSK’s advances in making clinical data public, but believed that the process has to be “enshrined in law”. Others were not so sure: Jackson was concerned with “over-sterilisation” of the system. “… if we legislate, and go too far, then we could end up stifling the system by not allowing it to breathe.” Transparency in the interest of patients But times are changing, said Soni. “The industry did have a very bad reputation and there is no doubt that it earned it. Some of the things it did were not in the interests of patients or for the best interests of care. However, the industry has changed – it’s had to. It had to realise some of the things it was doing were not of a suitable standard. And I think this is helping us to move further and further in the right direction.” George Freeman, minister for life sciences took up this theme in his keynote address… “We have a choice between historically justifiable conspiracy theory, distrust and legislation as the only solution – the law or the threat of law, which I think drives defensiveness – or an approach based on mutual respect for others’ perspectives. [That approach] will accelerate us into this landscape of a more transparent healthcare ecosystem, which I think is genuinely in the interests of all of us.”
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Pharma Guy
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GlaxoSmithKline has taken some bold steps to polish its image, tarnished by a Chinese bribery scandal and $3 billion settlement with the U.S. government. But naysayers blame its first big moves--nixing sales-rep quotas and pegging bonuses to "softer" measures instead--for disappointing roll-outs for several new meds.
Now that it's dropping the time-tested tactic of paying doctors to promote its meds, critics are piling on there, too. But the U.K.-based drugmaker is sticking to its guns, recruiting its own doctors and other experts to tout its meds.
As the Financial Times reports, GSK execs promise that the new policy won't backfire on its drug sales. In fact, the company says its pharma rivals will eventually follow suit.
It's a major shift for GSK, which shelled out $15 million in speaking payments to doctors in 2014, little less than it did in 2013. In addition to seminars headlined by internal doctors, the company will be using an increasing number of webcasts to communicate with providers. The company told the FT that about 400,000 medical professionals participated in GSK-hosted webinars last year.
Since GSK first announced its no-payment policy--which went into effect Jan. 1--other Big Pharmas have addressed the question. Will they do the same? Several companies are on record with an unequivocal "No," saying that their doctor-speakers are important to their promotional efforts.
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Using data from the Medicare Prescription Drug Program (Part D) and the Open Paymentsprogram, HealthGrove examined doctor prescribing rates for all of 2013 and pharmaceutical payments data from August to December of 2013. Within this data, a pattern emerges: doctors who prescribe a lot of drugs tend to get more money from pharmaceutical companies. Adjusting by physician specialty, the higher the doctor prescribing rate, the stronger the chance she receives pharmaceutical industry payments.
To categorize “high-prescribing” doctors, we looked at prescribing rates within the various specialities and grouped physicians into percentiles. The highest prescribers fell above the 80th percentile in either claim counts or claim costs per patient. Whether a doctor is writing more prescriptions per patient (claim count) or writing more expensive prescriptions per patient (claim cost), the trend remains the same.
The first tab, ranking prescription counts per patient, shows that 45.3 percent of the highest prescribing doctors (above the 80th percentile) received payments from the pharmaceutical industry, with the average payment totaling $146 per physician. On the other hand, only 21.4 percent of the lowest-prescribing doctors (those below the 20th percentile) received industry payments. And, if they did, the average payment was only $89. High prescribing doctors were not only more likely to receive payments from pharmaceutical companies, but these payments were also larger, on average.
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A UNITE HERE report [available here: http://bit.ly/AHAcontributions] has uncovered that the American Heart Association (AHA), its leadership, and authors of its guidelines accept large contributions from the pharmaceutical industry. As volunteers for the organization raise money in Heart Walks across the country, the labor union is calling on the AHA to take concrete steps to minimize the industry’s influence.
Dr. Robert Eckel, former AHA president and co-author of certain cholesterol-related AHA guidelines, received nearly $33K in industry payments in 2014. Over $14K came from drug maker Sanofi Aventis.. Express Scripts’ Chief Medical Officer Dr. Steve Miller wrote in July 2015 that the company’s new cholesterol-lowering drug, Praluent, and other “PCSK9-inhibitors” like it, could cost U.S. payers and patients more than $100 billion per year if not managed properly.
The AHA received over $15 million from pharmaceutical, medical device, and health-insurance companies in the 2013-14 fiscal year, including nearly $3.3 million from Pfizer.
Among other recommendations, UNITE HERE calls on the AHA to convene a panel of independent experts who do not receive income from pharmaceutical industries to review the 2013 ACC/AHA cholesterol guidelines and risk calculator.
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Medical professionals could be ordered to declare any financial ties to pharmaceutical companies under plans being considered by ministers
Doctors and health officials could be ordered to declare any financial ties to pharmaceutical companies under plans being considered by ministers. The undercover investigation disclosed how senior health officials who help decide which drugs are used by GPs and hospitals are being paid to work as consultants for pharmaceutical companies who want the National Health Service to “switch” to medicines they produce.
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Congress is now getting ready to pass the so-called 21st Century Cures Act. The draft bill, proposed bythe House Committee on Energy and Commerce, aims to foster medical innovation by streamlining the Food and Drug Administration's regulatory process and increasing National Institutes of Health research funding by $10 billion dollars. The draft, which has overwhelming bipartisan support, leads to many positive implications for patients, medical researchers and pharmaceutical companies.
However, the bill includes a passage which aims to amend a provision of the Physician Payments Sunshine Act, a law that requires drug companies to disclose their payments to individual physicians and teaching hospitals. The amendment would exempt pharmaceutical companies from reporting a major part of such payments that are made for continuing medical education or CME programs. The supporters of this change argue that physicians get to know about the latest developments in medical science through these programs, and requiring pharmaceutical companies to disclose such payments would discourage them from supporting the programs and ultimately inhibit medical innovation among doctors.
If we look at the data on these financial transactions, however, we get a much different picture. In the last five months of 2013, physicians who served as faculty or speakers on continuing medical education programs were paid more than $120 million dollars. The payments constitute 26 percent of the total financial transactions between pharma and individual physicians. The proposed change is essentially allowing pharmaceutical companies to hide more than a quarter of their payments to physicians.
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...essentially useless!