problem solved?…

Posted on Tuesday 13 October 2015


Pharmalot
by Ed Silverman
October 13, 2015

To disclose or not to disclose, that is the question. A new survey of UK health providers finds that an overwhelming majority of those queried – 87 percent – believe that payments from drug makers should be transparent. And 69 percent who currently have a relationship with at least one drug company say they have given – or are likely to give – permission to have payment information disclosed. The survey was conducted by the Association of the British Pharmaceutical Industry, which last year began publishing aggregated payments to doctors and, next year, will publish certain detailed fees. The move to disclose some payments came as part of an updated industry code of conduct, which occurred following concerns about financial ties between providers and companies.

“This project is another step on our journey towards greater transparency, which will allow patients and others to fully understand our relationships,” said Virginia Acha, an ABPI executive director, in a statement. The trade group queried 507 doctors, nurses, hospital specialists, and pharmacists. Nonetheless, there is still some resistance.

Thirty-two percent believe it is unnecessary for drug makers to disclose payments to individual health care providers, and 26 percent feel disclosure will adversely affect medical innovation. Meanwhile, 75 percent said disclosure will not affect their relationships with industry, although 23 percent of general practitioners said they will be less likely to work with drug makers if payment data is published. By contrast, 17 percent of hospital specialists felt similarly. The issue has generated considerable attention, especially in the United States, where a federal database called Open Payments launched last year. The Centers for Medicare & Medicaid Services created the database in response to a US Senate investigation several years ago that raised questions about undue influence drug and device makers may have on medical practice and research.

Although critics of the Open Payments database regularly expressed concern that disclosure would dissuade many physicians from participating in research, there is no indication, to date, to suggest this has happened. The United Kingdom has trailed in mandating disclosure thanks to the ABPI, which has tried to get ahead of the curve and ward off government requirements. But the UK government may require disclosures after an undercover newspaper investigation this summer showed drug makers allegedly paid National Health Service staffers to use specific medicines.
John CalvinMy early years were spent living on the campus of a boys military school where my father taught and coached, a school I later attended for a few years. It was founded and run by a family of [fundamentalist] Presbyterians [of the Scottish John Calvin kind] – an overdose of the Protestant Work Ethic, a strict unforgiving morality, and chapel at least twice a day. By their read, the appearance of sin was almost as bad as the real thing. In mid high school, I fled to a normal 1950s school where I thrived – free at last! But I think some of that Calvinism must’ve gone all epigenetic in those years, because I still can’t think of any reason for physicians to be paid by drug companies unless they work for them. And that feels like it’s in my DNA. Given the choice, I’d rather not have to deal with COIs at all. So although I’m glad that articles now have industry affiliations listed, that there’s a ProPublic Database, and that we passed a Sunshine Act, in my heart of hearts, I’m a Calvinist about doctors with industry ties – the appearance is almost as bad as the real thing. And there’s nothing in all the corruption and scandal [particularly in my specialty of psychiatry] to temper my uncharacteristic moral rigidity on this point. I now read articles in this specific order:

  • the title
  • the author by-line and the funding sources
  • the COI declaration and the acknowledgements
  • and then I read the article
While I traced my feelings about these matters to my school days, I sort of know better. Morality develops from examples set by parents and other admired figures along the way. To my knowledge, none of my mentors in either Internal Medicine or later Psychiatry were on any industry payroll. And in so far as I know, the first was a Grand Rounds presenter in the early 1980s named Richard Borison [later a Department Chairman, until he was convicted to spend ten years in prison for stealing millions from his university in a Clinical Trials scam]. I don’t really know if my view on this topic is too high and mighty or not, though I do know it’s a minority report. Whichever the case, I’m glad about our requirement for COI transparency, and equally pleased the UK is coming on board. But I’d be lying if I said "problem solved"…

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