July 2013
Question: A patient found my name in a database on www.propublica.org, which shows that I have received a $1,000 consultant fee from a pharmaceutical company. My patient asked if the payment affects my prescribing. What is this website? How should I discuss physician-industry relationships with my patients?
Answer: ProPublica is a nonprofit news organization focusing on independent investigative journalism. Founded by philanthropists in 2008, it has reported on topics from the BP oil spill to housing foreclosures. In 2009, ProPublica started investigating ties between physicians and drug companies, which led to the “Dollars for Docs” series of online articles. They also created a database listing more than $2 billion in payments from 15 pharmaceutical companies to physicians and other health care providers. These data come from companies that are required by state laws or legal settlements to disclose the payment information.
Eventually, all drug and device manufacturers will be required to disclose such payments under the Physician Payment Sunshine Act. The act covers physicians, teaching hospitals, and any entity that receives payments for a covered recipient, such as grants or charity contributions. The act does not cover physicians who are employees of the company making the disclosure, nor does it cover licensed health professionals other than MDs and DOs. The deadline for companies to report payments is March 31, 2014, and the payments will be published on Sept. 30, 2014 (June 30 in the following years).
ProPublica’s belief that patients want to know if their doctor is receiving compensation from a company was confirmed in a 2010 Consumer Reports survey. Of 1,250 respondents, 70 percent said doctors should tell their patients if they are being paid by the company that makes the prescribed drug. In addition, 75 percent said they would be concerned about getting the best treatment if their doctor were accepting drug company payments. To respond to these concerns, ophthalmologists should learn how to explain ethical relationships with industry.
When responding to patients about this issue:
1. Be forthcoming. Explain what the payment was for and whether that particular company manufactures any of your patient’s prescriptions.
2. Don’t rush to separate industry and medicine. Instead, explain the connection and describe how physicians move therapies from the lab to the clinic by assisting with pharmaceutical trials.
3. Discuss the benefits. Even for drugs that are already approved, there are ethical reasons for a physician to speak or consult for a drug company. Practice patterns are difficult to change, and companies utilize physicians to educate one another. Articulate the importance of these relationships to curious patients.
For more information or to submit a question, contact the Ethics Committee staff at ethics@aao.org.