It has long been a practice of the pharmaceutical industry pay doctors for a variety of purported purposes such as consulting research and speaking. As often as not, these payments are intended to and do effectively influence the doctors in the prescription of the drug companies‘ products.
There are many doctors that make significant income off these arrangements. It is not unheard of for the doctor to make more from the drug companies than from his or her medical practice. The potential for conflicts of interests hardly needs stating.
A new law when passed will require pharmaceutical companies to disclose all payments to doctors. This will include research money, speaking engagements, travel, meals and even according to the New York Times, bagels and coffee brought for the doctor‘s office staff on visits from the pharmaceutical sales representative.
Research has shown that these pharmaceutical practices, until now somewhat in the dark, do in fact influence doctors‘ prescription habits. Among the more troubling findings is that doctors often will prescribe the medicines off label for unapproved purposes despite obvious dangers of such off label prescription practices.
It is hoped that the new law and disclosure requirements will increase the chances that doctors are making drug prescription decisions based entirely on the well-being of their patients. In addition to the light that these financial disclosures will shed on current and future practices, they may also reveal possible issues related to past practices of both drug companies and doctors.
There has been significant evidence that these payments influence treatment decisions. Of particular interest will be the financial incentives given to doctors for the prescription of known dangerous drugs such as Actos which has been shown to cause bladder cancer. It will also be interesting to understand doctors‘ incentives in prescribing drugs off label.
The New York Times found that the doctors that benefit from these pharmaceutical payoffs practice medicine differently from their counterparts who do not. These doctors are more willing to prescribe risky drugs and to prescribe drugs for unapproved uses. Sometimes they do both according to the Times when for example they prescribe powerful antipsychotic drugs to children.
This all sounds good so far. The penalties range from $10,000 to $100,000 per violation. However, the maximum fine is only $1 million per year. When speaking of pharmaceutical companies that bring in billions upon billions of revenue each year, this is a pittance and a small cost of doing business.
Due to the relatively low fines for violations, these practices will likely continue unabated at least from the pharmaceutical industry side of the equation. What is far more interesting and far more likely to effect change is the potential light this will shed on individual doctors and medical providers which may lead to medical malpractice claims. In fact, isn‘t the discussion that we should be having about a doctor‘s duty to disclose conflicts of interest that might be detrimental to the health of his or her patients?