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Will Disclosure Quiet the Industry’s Critics?

Will Disclosure Quiet the Industry’s Critics?. Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009. Why a Doctor Gifts Registry?. Transparency/accountability to patients.

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Will Disclosure Quiet the Industry’s Critics?

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  1. Will Disclosure Quiet the Industry’s Critics? Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009

  2. Why a Doctor Gifts Registry? • Transparency/accountability to patients

  3. Statement by American College of Physicians “What would my patients think about this arrangement? What would the public think? How would I feel if the relationship was disclosed through the media?” Source: Ann Intern Med 2002;136:396-402

  4. Why a Doctor Gifts Registry? • Transparency/accountability to patients • Restore trust in medical profession • Facilitates kickback investigations • Transparency/accountability to providers • Transparency/accountability to payors • Promotes research (esp. if names provided) • Facilitates journalistic investigations

  5. Uses by Journalists • Investigative pieces by local journalists • Comparisons by specialty • Links to “thought leaders” • Links to state disciplinary actions

  6. Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004 Sources: JAMA 2007;297:1216-23; JAMA 2008;300:1998-2000

  7. Purpose of Payments >$100 to Physicians in Vermont, 2002-4

  8. Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004 • High rates of underreporting • Companies report $millions one year, nothing the next • Responses non-standardized • Aggregation by physician and by gift • Exemptions • Samples • Research studies • Limited accessibility • Lack of online submissions or reports • Need to file lawsuit in Vermont • Lack of national standardization

  9. Problems with the Physician Payment Sunshine Act, 2009 • Exclusions • Samples • Research on unapproved products • Gifts totaling <$100 per year • Gifts to other professionals • No payments to organizations • MECCs and PBMs • Patient groups • Hospitals and medical schools • Professional organizations • No judicial review • Low penalties • Intentional non-reporting: cap of $1 million/year

  10. Framework for AddressingConflict of Interest

  11. Research Payments to Physicians

  12. Non-research Payments to Physicians

  13. Pharmaceutical Company Promotional Expenditures, U.S., 2004 • Total expenditures • Promotion: $57.5 billion • Research: $31.5 billion • As % of retail sales • Promotion: 24.4% • Research: 13.4% • $61,000 on promotion per physician Source: PLOS Medicine 2008;5:e1

  14. Q: Will Disclosure Quiet the Industry’s Critics?

  15. Q: Will Disclosure Quiet the Industry’s Critics? A: No

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