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Who’s Really Prescribing Your Medicine? It May Not be Your Physician.

Published onNov 07, 2014
Who’s Really Prescribing Your Medicine? It May Not be Your Physician.

Patients aren’t the only ones paying a premium to doctors and other healthcare providers. In the last five months of 2013, drug and medical device companies paid at least $3.5 Billion to U.S. physicians and teaching hospitals. In addition to raising a few eyebrows, the large sums of money these companies are paying out have raised several questions about the conflicts of interests these payments create.

Public information on payments made to doctors and teaching hospitals has only recently been made available thanks to the “Sunshine Provisions” of the Affordable Care Act, which went into effect August, 2013. The purpose of the enacted regulations is to drive down healthcare costs by making the public aware of potential conflicts of interest. The Center for Medicare and Medicaid Services (CMS) breaks down the data into three types: 1) Research; 2) Ownership; 3) General (non-ownership, non-research). Of these three categories, research and general payments have drawn the most scrutiny and criticism.

Payments to individuals and teaching hospitals conducting research has drawn criticism for potentially leading to biased results. For example, despite the peer review process, the New England Journal of Medicine published an article which praised the benefits of the diabetes medicine Avandia; an article whose 11 authors all received some form of payment from the drug’s manufacturer. Though it’s difficult to prove bias after a study has been completed, Avandia was ultimately recalled after being linked to approximately 83,000 heart attacks and deaths. In addition to for-profit research entities which receive payments, the Sunshine Provisions also require disclosures by an often overlooked entity, research hospitals. It’s easy recognized potential biases when researchers receive money from the manufacturers of drugs they are studying. Just as important, is recognizing the growing prevalence of leaders at academic medical centers, who are also pharmaceutical company board members. These leaders hold a considerable amount of influence over research, yet at the same time are looking out for the financial best interests of the companies they work for. While the conflicts of interests raised by both individual and institutional conduct was never illegal per se, the regulations of the Sunshine Provisions can help shed more light on the potential ethical dilemmas posed by pharmaceutical companies’ financial leverage on research studies.

Payments and financial incentives to researchers are troubling, but even more prevalent are the direct and indirect payments made to individual physicians. In recent years, pharmaceutical companies have spent more than $24 Billion marketing their products to physicians. Perhaps unsurprisingly, recipients of meals and speaking or consulting fees were twice as likely to prescribe a company’s product as typical doctors. Even though most large contributions go to important physicians who deliver lectures to their colleagues, even relatively small amounts of contributions can have an effect on doctors’ prescribing choices. In addition to potentially influencing a doctor’s decision to prescribe a certain medicine, critics of payments to physicians point out that these payments contribute to already expensive healthcare costs.

The Sunshine Provisions of the Affordable Care Act provide long awaited transparency to a widespread system of payments to physicians and teaching hospitals. Some of the payments are well intentioned, and are much needed to fund research for new drugs and medical devices. However, by their nature, these payments have the potential to create conflicts of interest and negatively affect patient health. The Sunshine Provision has not made any of these payments illegal, rather it simply requires that these payments be reported and made publicly available. Through this process, patients and consumers have more information at their disposal to truly make informed decisions about their healthcare.

*Jaime C. Garcia is a second year student at Wake Forest University School of Law. He holds a Bachelor of Arts in Government and a Bachelor of Science in Communication Studies from the University of Texas at Austin. Upon graduation he intends to practice corporate litigation.

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