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Public Trust and Transparency

Posted Jun 02 2009 4:35pm
Keeping the Faith with Patients

Constructive collaboration between doctors or researchers and industry can be important in advancing the health of the public. These relationships can promote the development of new medications and medical devices, but they may also pose the risk of biased judgment. Some relationships have risks but little or no benefit—aside from perks such as free meals or logoed trinkets or payments for industry controlled speeches. There is rising concern among the public and legislators that these gifts might have undue influence on doctors and their care of patients.

Some health care providers are dismissive of the idea that their medical judgment could be swayed by giveaways. But the Pharmaceutical Research and Manufacturers of America (PhRMA) seems to have recognized the concerns as well as the threat of legislation. New voluntary guidelines from PhRMA, which took effect January 1, 2009, dissuade drug companies from distributing what is estimated to be nearly $6 billion worth of gifts each year. In addition, some institutions such as the Cleveland Clinic have begun disclosing financial ties between their staff and drug and device companies. These actions are part of a growing movement toward increased transparency and elimination of certain relationships between doctors and industry in order to shore up the public trust in medicine.

Some lawmakers remain skeptical that voluntary actions will eliminate the risks from doctor-industry financial relationships and would like to see regulation go further. In January, Senators Chuck Grassley (IA) and Herb Kohl (WI) re-introduced the Physician Payments Sunshine Act, first introduced in 2007, which would require drug and biotech companies to report all payments made to physicians or physician practices or face financial penalties. If information is out in the open, in the view of some, doctors may be more inclined to police themselves, and patients will be better equipped to evaluate whether their doctor may have conflicts.

While voluntary guidelines can be valuable, to truly ensure trust in the medical field, stricter policies will be necessary, according to a recent Institute of Medicine report, Conflict of Interest in Medical Research, Education, and Practice. The report calls for institutions such as academic medical centers, professional societies, and medical journals to establish formal conflict of interest policies and procedures. The goal is to prevent questionable relationships between industry and physicians, researchers, and medical institutions that can threaten the public’s confidence in medicine. The report’s authors also recommend that Congress take the "sunshine" idea further by creating a national program requiring pharmaceutical, medical device, and biotechnology companies to publicly report payments not only to  physicians but also to biomedical researchers and medical institutions. With this information readily available, universities, journals and other organizations can verify the completeness and accuracy of disclosures of researchers and others, and doctors will be better able to reassure patients that their clinical decisions are made with the patients’ best interests in mind.  

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