Laws in two states requiring disclosure of pharmaceutical company payments to physicians do not provide the public with easy access to payment information and are of limited quality when accessed, according to a study in the March 21 issue of JAMA.
Interactions between the pharmaceutical industry and health care professionals often involve payments, including cash, gift certificates, meals, textbooks or conference fees. In contrast to many other professions, medicine allows payments from a company to an individual who decides whether and how often to use products produced by the company. "To avoid undue influence, the American Medical Association recommends that gifts (but not other payments) to physicians should benefit patients and should not exceed $100 in value, a recommendation similar to those of other medical organizations and the Pharmaceutical Research and Manufacturers of America," according to background information in the article.
Recent legislation in five states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In two of these states, Vermont and Minnesota, payment disclosures are publicly available.
Joseph S. Ross, M.D., M.H.S., of Mount Sinai School of Medicine, New York, and colleagues analyzed publicly available data in Vermont (from July 2002 through June 2004) and Minnesota (from January 2002 through December 2004).
The authors found that the laws enacted by Vermont and Minnesota fail to provide the public with easy access to information about payments from pharmaceutical companies to physicians and other health care professionals.
"In Vermont, 61 percent of payments were not released to the public because pharmaceutical companies designated them as trade secrets and 75 percent of publicly disclosed payments were missing information necessary to identify the recipient," the authors write. "In Minnesota, 25 percent of companies reported in each of the three years."
The study also found that pharmaceutical companies made substantial numbers of payments of $100 or more to physicians.
"In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2,416 payments of $100 or more to physicians," the authors write. "In Minnesota, among 6,946 payments totaling $30.96 million publicly disclosed, there were 6,238 payments of $100 or more to physicians."
The authors believe that the information obtained through disclosure laws is insufficient for revealing the true pattern of payments.
"Making these payments publicly available will require more stringent laws with clear mechanisms for enforcement," they conclude.
(JAMA. JAMA.2007;297:1216-1223. Available to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: SUNSHINE LAWS AND THE PHARMACEUTICAL INDUSTRY (JAMA Editorial)
In an accompanying editorial, Troyen A. Brennan, M.D., M.P.H., of Aetna Inc., Hartford, Conn., and Michelle M. Mello, M.Phil., Ph.D., J.D., of the Harvard School of Public Health, Boston, write that the findings of Ross and colleagues are discouraging.
"First, numerous payments to physicians exceeded the $100 limit that has been suggested by the American Medical Association," they write. "Second, and worse, there are many holes in the reporting."
"To be clear, for-profit industries do not share the same ethical norms to which physicians and other health care professionals must adhere. Their primary commitment is to create shareholder value, not maintain an altruistic commitment to patients," they write. "But at some point the leadership of the pharmaceutical industry and their boards of directors must begin to recognize that growing public and professional mistrust could substantially detract from that value."
(JAMA. 2007;297:1255-1256. Available to the media at www.jamamedia.org)
Editor's Note: Please see the editorial for additional information, including financial disclosures, funding and support, etc.