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Patients want to know about their docs’ financial conflicts of interest

The new health care legislation signed by President Obama in March contains a little-known section called the Physician Payments Sunshine provision.

The new health care legislation signed by President Obama in March contains a little-known section called the Physician Payments Sunshine provision. It requires drug and medical-device companies to record, starting in 2012, any physician payments that exceed $10 in a searchable public database. That database must be up and running on Sept. 30, 2013.

As a Star-Tribune editorial noted last week, “[t]he Sunshine reforms are an overdue dose of medicine to make providers and industry more accountable to the public. For far too long, too little has been known about vast sums of money [$30 billion annually, including $1 billion in lunches alone] flowing from industry to doctors.”

The public seems to agree. In a new review and analysis of 20 previously published studies, Yale researchers report that patients — and people participating in clinical trials — want to know the financial relationships between their physicians and drug companies.

“Patients believe that [financial ties] influence professional behavior and should be disclosed,” the authors of the review, published Monday in the Archives of Internal Medicine, conclude. “Patients, physicians, and research participants believe [financial ties] decrease the quality of research evidence, and for some, knowledge of [financial ties] would affect willingness to participate in research.”

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A few interesting details from the analysis:

  • Younger, more educated patients had the greatest interest in physician disclosure of financial conflicts of interest. 
  • Patients found personal gifts to physicians from industry sources more problematic than professional gifts. One 2009 study included in the review found, for example, that 9 percent of patients disapproved of their physicians receiving free drug samples and 16 percent disapproved of them receiving free medical texts. But when it came to paid dinners and golf tournaments, 55 percent and 68 percent of the patients disapproved, respectively.
  • Patients would prefer to learn about their physician’s financial ties through a conversation with their doctor rather than through some kind of written communication.
  • Some evidence suggests that when physicians disclose such financial incentives from industry, their patients’ trust in them may actually increase.
  • Only about one-fourth of people participating in clinical trials were less willing to do so after learning about the financial ties to industry of the researchers conducting the trials.

In an editorial accompanying the new review and analysis, Eric Campbell, PhD, an associate professor of medicine at the Harvard Medical School who conducts research into physician conflicts of interest, warned physicians and companies (gently) that they shouldn’t fight this new push for transparency:

[I]t seems likely that public disclosure is a first step toward a more active role by government and health care institutions in evaluating and managing physician-industry relationships. This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy. Other physicians will see it as necessary step to begin to restore the professional identify of medicine in the eyes of the public and policymakers. Companies, whose primary interest is generating money for shareholders, may well see this as a slow death of the current model of marketing drugs and devices to physicians by plying them with gifts, meals, trips, etc. In the least, these relationships will no longer be a part of the hidden culture of medical practice in the United States, and this transparency will help prevent the further erosion of public trust in the medical profession.