Transparency is a powerful tool. Framed properly to illustrate the collaboration between America’s biopharmaceutical companies and physicians, it can empower patients to become more engaged in the care they receive. Transparency can also lead to misinterpretations, discouraging even the most ethical, unbiased doctors from future collaborations that could improve patient health.
ProPublica, whose reporters, Tracy Weber and Charles Ornstein, penned The Times’ Sept. 8 Op-Ed article, “What the doctor ordered,” recently updated its “Dollars for Docs” database of doctors who have received money from biopharmaceutical companies. By listing only names and compensation figures with limited context, patients may assume their care is compromised by tainted doctors. Such an incomplete picture creates unnecessary confusion and, in most cases, is completely unfounded.
We agree with ProPublica that patients should know that many physicians work with biopharmaceutical companies. To be completely transparent, however, they should also know why it benefits them and how the relationship is closely managed to ensure it remains ethical.
From consulting on research to helping other physicians learn about the most up-to-date clinical data, physicians play a productive role in America’s biopharmaceutical ecosystem. Company-sponsored peer education programs, for example, allow expert physicians to engage their fellow healthcare providers and exchange the latest FDA-regulated data on new medicines, new uses of existing medicines and new safety information. For their time away from their practices, these physicians are reasonably compensated.
Likewise, representatives from biopharmaceutical companies can provide important information to physicians, whose daily schedules of back-to-back appointments with patients leave little time available to discuss new medicines. In some cases, companies provide informational presentations to physicians and their staff during one of the few free moments of their busy days: lunch.
Access to this information is essential for physicians, who juggle the demands of patient care with the need to stay aware of ever-evolving science. Last year alone, 21 new medicines were approved by the Food and Drug Administration; patients deserve doctors who are well versed on these cutting-edge medicines as they become available.
According to recent research, these programs work. A survey by KRC Research for my group, the Pharmaceutical Research and Manufacturers of America (PhRMA), found that roughly three-quarters of physicians attend peer speaker programs, including 86% in rural areas where physicians would otherwise have limited access to professional development opportunities. Nine out of 10 attendees reported that the information they received was up-to-date, useful and reliable, and more than half said they often gain knowledge or skills helpful to their practice. These speaker programs complement other sources of professional education, such as medical association-led conferences, by facilitating physician-led exchanges of the latest regulated information about the benefits, risks and appropriate uses of medicines.
Importantly, the doctor-biopharmaceutical company relationship also allows us to obtain on-the-ground information from physicians more easily, helping companies to target future research and respond to treatment gaps.
While ProPublica and the critics they cite imply that physicians are influenced — consciously or not — to make judgments not in their patients’ best interest, the KRC survey found that physicians factor many considerations into their prescribing decisions, including clinical practice guidelines, a patient’s financial and insurance status, and, of course, the patient’s health, including drug interactions and side effects. Indeed, nearly 80% of prescriptions written in America are filled with a generic drug.
We stand by the quality of these ethical relationships and, therefore, we support transparency. We understand that patients may want to know if their physicians collaborate with companies, and they should also understand how their care improves as a result. That is why we supported the physician payment sunshine provisions of the 2010 healthcare reform bill, which will require companies to report payments for services or other transfers of value to physicians, with the government posting this information on a public website. We eagerly await regulations on how to proceed with implementation. Companies also comply with internal policies, FDA regulations and the PhRMA Code on Interactions with Healthcare Professionals, which includes details specific to peer speakers’ medical expertise, reputation and experience. These relationships are closely monitored to ensure they remain informative and ethical.
Unfortunately, ProPublica’s Dollars for Docs series — the name alone is enough to convey the sensational nature of the material — threatens to potentially undermine the ultimate goal of these interactions: strengthening patient care. The fact is, ProPublica’s series would not be possible if many companies were not already being transparent about relationships with physicians.
The lesson is clear. Rather than be alarmed, patients should take pride in their doctors serving as part of a vast team of scientists and physicians who closely monitor the medicines they prescribe, share findings with healthcare peers and offer feedback to biopharmaceutical companies. The collaborative relationship between doctors and the biopharmaceutical industry ensures that cutting-edge treatments will continue to enhance patient care.
Diane Bieri is the executive vice president general counsel for the Pharmaceutical Research and Manufacturers of America. This piece originally appeared in the Los Angeles Times.