Viewpoint

Disclosure Dilemmas

Larry E. Patterson, MD
From The Chief Medical Editor

The National Transportation Safety Board recently concluded that texting, emailing or talking on a cell phone while driving is just too dangerous to be allowed, and now urges all states to impose total bans, except in case of emergency. A survey by the National Highway Traffic Safety Administration of over 6,000 drivers suggests that we agree — sort of. That survey found that while many drivers don't think it's dangerous when they themselves text or email while driving, they do believe it's unsafe when others do.

We often think that only others are affected or influenced by outside forces, not us. Now consider that in the context of the new Physician Payments Sunshine Act, which is about to go into effect this year. (It had been scheduled to start January 1st, but was delayed when CMS missed its deadline. Go figure.) This new law, discussed in detail in this issue beginning on article ‘Who Gets Burned by The Sunshine Act?’, will require companies that give you anything of value over $10 to report such heinous actions to the government. And guess what? By late next year, your patients will be able to look on the Internet and find exactly how much you've been given!

This law came into effect in part because of some real abuses in the system. I've watched my colleagues in other medical specialties be lavished with ski trips and other vacations as a reward for using a generous company's products. Far more egregious abuses have been cited through the years. I even attended a pharmaceutical meeting years ago, purportedly as a consultant to give the company feedback, getting a nice weekend in New Orleans, all expenses paid, plus a stipend. It turned out to be mostly a promotional junket for the company's products. So I understand that some industry shenanigans do occur (or used to, at least) and that we'd be better off as a profession if we avoided it.

But is this law really a good idea, going down even to $10? While it seldom happens in our practice, occasionally a drug rep will provide lunch for our staff so they can take an extra 20 minutes while I'm stuffing my face to inform me about something new they'd like me to try. Essentially they are paying me for my time, since they all know I really don't have more than 30 seconds in the back hallway to see them in between patients. But surely I don't change my prescribing habits based on a $10 box meal! Or do I?

We all say adamantly that these things don't influence us. However, when you come right down to it, the companies are probably not spending money and time wining and dining us if they aren't showing a profit in doing so. Imagine the marketing meeting at a big pharma company where they found out that after spending millions of dollars on meals and such, it didn't influence the doctors at all. Of course it does. Or at least it affects all of you. Just not me.

It's a dilemma. On the one hand, disclosure sounds like a good thing. On the other hand, it's patronizing and insulting to doctors for us to be perceived as capable of being bought. I'm a bit uncomfortable knowing that my patients will be able to learn who bought me a sandwich — and that it might lead them to make unfounded assumptions about my integrity.

CMS will be accepting feedback about the law until February 17th; you can comment at www.regulations.gov. In the meantime, I'm pledging to quit texting while driving, and will at least try to limit my phone calls.