Disclosure Can Address Doctors' Conflicts of Interest


Eighty-four percent of American physicians have a financial relationship with a drug or medical-device company, according to the Archives of Internal Medicine. For more than a year, I was one of them.

When I was a psychiatrist in private practice, a drug company asked me to educate physicians about the benefits of its antidepressant. I was paid up to $750 a session for my efforts.

As a result, I saw firsthand how a simple exchange of money could undermine the objectivity of a well-meaning doctor. I oversold the scientifically demonstrated benefits of the drug and downplayed its equally well established disadvantages, rationalizing my behavior all along.

Ultimately, I grew uncomfortable with my dual role as health-care provider and drug representative, and I ended my relationship with the company.

I can't help thinking that if I'd received some instruction on this subject during my medical training, I would have been better equipped to understand what I was getting myself into. That's why I'm now working to strengthen conflict-of-interest policies among medical schools and hospitals, and to encourage implementation of legislation requiring drug and device makers to divulge their payments to physicians.

This work builds on efforts such as the PharmFree Scorecard, a five-year-old initiative of the American Medical Students Association. The scorecard grades medical schools' policies on interaction between doctors and drug and device companies. The latest edition, for 2011, gave 102 schools A's or B's, up from only 22 in 2008. We're making progress, but there's more work to do.

Two years ago, Congress passed the Physician Payments Sunshine Act as part of the health-care reform law, requiring drug and device companies to disclose financial relationships with physicians and teaching hospitals. Once the provision is fully implemented, patients will be able to look up their doctors online and find out how much money they've received from the businesses whose products they prescribe.

The legislation was supported by both Democrats and Republicans, as well as leading consumer and medical groups - including the American Medical Association, which represents most U.S. physicians. It also reflects the recommendations of the Institute of Medicine, the medical arm of the National Academies of Science.

Unfortunately, the Obama administration has fallen at least a year behind schedule in its efforts to put the provision into effect. Last year, the Pew Health Group, Consumers Union, and Community Catalyst joined forces with leading drug and device industry associations to urge the Department of Health and Human Services to implement the legislation swiftly, noting that it will protect patients and help restore trust in our health-care system. With such broad support for the program, there's no good reason for further delay.

Monetary relationships among doctors and drug and device companies are not inherently bad; in fact, they are crucial for advancing medical research and patient care. Yet they can also skew prescribing practices and research results. That's why transparency and education are such an elegant solution: They allow these often important relationships to exist, but only on the condition that other professionals and patients are fully informed about them.

Daniel J. Carlat is director of the Pew Prescription Project. He is scheduled to speak to researchers, executives, and other physicians at a conference hosted by the Drug Information Association in Philadelphia on Wednesday. He can be reached at dcarlat@pewtrusts.org.

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