{"id":360,"date":"2010-10-23T13:09:41","date_gmt":"2010-10-23T20:09:41","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=360"},"modified":"2010-10-23T13:09:41","modified_gmt":"2010-10-23T20:09:41","slug":"dollars-for-docs","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=360","title":{"rendered":"Dollars for Docs"},"content":{"rendered":"

\"\"I apologize to my loyal readers for not posting in a long while. \u00a0Fortunately, I was awakened from my torpor by an eye-opening new database that lists some<\/em> of the money paid to specific doctors by pharmaceutical companies. \u00a0The Pulitzer Prize\u00a0winning investigative journalists at ProPublica<\/a> tapped the public disclosures of seven companies that have begun posting names and compensation on the internet, some as the result of legal settlements. \u00a0ProPublica’s “Dollars for Docs<\/a>” provides both an overview of the issue, as well as a handy database search function. \u00a0It is easy to look up specific doctors, or (as I did) \u00a0to scan through a whole city or town to see who received money from these seven companies in the past two years.<\/p>\n

Some caveats<\/a> are important. \u00a0First, the seven companies represent just over a third of all pharmaceutical sales in the U.S. \u00a0The health care reform law, signed in March, mandates that all<\/em> drug companies report such data to the federal government beginning in 2013. That information will be posted on a government website. \u00a0So, this is a preview of the data to come. \u00a0Research funding is not included here, only speaking, consulting, and related activities. \u00a0It is also important to keep in mind that listed payments are not automatically unethical or illegitimate. \u00a0For example, honest consulting relationships between doctors and drug companies reasonably include travel expenses and a consulting fee.<\/p>\n

Nonetheless, most of the listed activity is pretty suspect. \u00a0I first learned about “Dollars for Docs” from Dan Carlat’s blog<\/a>. \u00a0As Carlat points out: “The vast majority of payments are for doctors who give ‘educational’ talks to other doctors, presumably focusing on one of the drugs made by the funding company.” \u00a0And as he notes, the sheer enormity of the database is probably its most striking aspect \u2014 published surveys show that well over 100,000 doctors receive cash from drug companies. \u00a0Most of the amounts in the database are small, up to a few thousand dollars, not much compared to the income of most doctors. \u00a0But some are considerably higher. \u00a0My eye-opening experience was to scan the list of San Francisco doctors, where I found a few colleagues I know who added tens of thousands to their income in 2009 and 2010 speaking for drug companies. \u00a0It makes me think differently about those doctors \u2014 which is the point, right?<\/p>\n

Supporters of the status quo argue that there are many other potential conflicts of interest, and that not all recipients of industry money are necessarily biased. \u00a0Both of these points are true, but irrelevant. \u00a0Money is universally recognized as motivating; that’s why people are paid to work. \u00a0A universally recognized motivation, voluntarily chosen and standing here in plausible conflict with unbiased patient care, should be unacceptable from the perspective of medical ethics. \u00a0Medical ethics does not stop with financial conflicts of interest. \u00a0Physicians are prohibited from sexual relations with patients for similar reasons: A sexual motivation is very likely (although not absolutely guaranteed) to conflict with clinical care. \u00a0Other systematic sources of bias will be addressed when they can be identified and controlled. \u00a0The fact that we can’t minimize all sources of bias is not a compelling reason to ignore obvious financial ones.<\/p>\n

When comprehensive numbers are available online in 2013, we will finally have meaningful disclosure about this potential conflict of interest. \u00a0What we as a profession, or as the public, do with these disclosures is another matter. \u00a0As I’ve noted before<\/a>, the public seems more concerned than the medical profession itself about industry-fueled bias. \u00a0To that end, patients may begin to use such public databases as a means to choose doctors. \u00a0The website of the newly formed Association for Medical Ethics<\/a> features a searchable database similar to “Dollars for Docs” but with a more explicit message: that accepting industry support is unethical in clinical practice. \u00a0If this idea catches on \u2014 and I suspect it will, at least in some areas \u2014 speaking and consulting fees will not be the only financial motivation at play here.<\/p>\n","protected":false},"excerpt":{"rendered":"

I apologize to my loyal readers for not posting in a long while. Fortunately, I was awakened from my torpor by an eye-opening new database that lists some of the money paid to specific doctors by pharmaceutical companies. The Pulitzer Prize winning investigative journalists at ProPublica tapped the public disclosures of seven companies that have […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[10,13,16],"class_list":["post-360","post","type-post","status-publish","format-standard","hentry","category-medicalpsychiatric-education","tag-carlat-psychiatry-blog","tag-ethics","tag-pharmaceutical-marketing","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/360","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=360"}],"version-history":[{"count":5,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/360\/revisions"}],"predecessor-version":[{"id":367,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/360\/revisions\/367"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=360"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=360"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=360"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}