Friday, March 04, 2005

A Public Register for Physician-Drug Company Interactions

Joseph S. Alpert, MD wrote a recent editorial in the American Journal of Medicine. In it, he suggests a (partial) solution to the pharmaceutical industry's inordinate influence on physician prescribing habits. He suggests a national, public database that logs all "transactions" between doctors and the drug companies.

Sample entries would be:

"Dr. Q whose office address is 34 Main Street, Maintown. , USA received travel expenses valued a $670.00 to attend the annual national meeting of Medical Society W from Major Pharmaceuticals, Inc. of Township G, New jersey."

or

"Professor U of H Medical School is a major partner in the new start-up company, B Pharmaceuticals of Maintown, USA> The value of Professor U's stock is estimated to be $500,000."

(personally, I'd have liked to receive the latter.)

The idea is that patients could check out potential conflicts of interest their doctors might have and thereby be able to more more "informed" decisions.

I don't particularly care for this idea. Besides being difficult, time consuming and expensive to manage administratively, to me, it will do more to foster confusion and mistrust in patients with very little upside. Of what real use will this information be to the patient (other than providing a rather prurient insider look into the inner dealings of their doctor)? I don't think that it will result in more informed decision-making on the part of the patient.

To me, the relationship between doctors and the drug companies is what needs to be dealt with. Merely bringing it to light is not a solution but merely a start.

Dr. Alpert suggests that the relationship between doctors and the drug companies is inevitable:

"In our capitalist society, marketing of any product to any group of potential users is legitimate and acceptable."

This seems fatalistic. Certainly things can be done which will get more to the root problem such as better physician education and limiting the reach of advertising. As Dr Alpert suggests, we do practice medicine in the framework of free market. That doesn't mean however that the general public has no overriding interest. It often does and protections can legitimately be superimposed over a free market.

I often feel that patient's have too much information rather than not enough. Information overload is a very real phenomena. When we decide to provide greater transparency and openness to patients, we have to decide whether that increased information will be truly useful or whether it simply adds to the cosmic "noise".

2 Comments:

Blogger Henry Stern, LUTCF said...

You make some interesting points.

I do take issue, however, with your statement that

patient's have too much information rather than not enough.I see just the opposite. As a proponent of consumer driven health care, I urge my clients to do as much research as possible, not to try 2nd-guessing the provider, but to be able to make an informed decision regarding their own healthcare.

Recently, the Medical Director of Humana (the insurance carrier) spoke to a group of us about exactly that. He advocates that insureds (i.e. patients) use the web to learn about their conditions. Of course, there's bad info out there as well as good, but it's a start.

Not to "flog my blog," but I recently posted on a related topic: pending legislation that would require providers to inform patients of the costs of given procedures, in advance.

March 04, 2005 2:29 PM  
Blogger chargemaster said...

hgstern
I have to agree with you that patients do not have too much information.

By helping the patients become more informed or even educated about procedures and supplies, I believe that the cost of healthcare could be reduced. There could be less visits to the ER or the Urgent Care if the patient knows that what they have is just a cold instead of the flu. Another example could be that the patient calls around for prices of a specific surgery and then goes with the cheapest. This can drive other hospitals to review thier pricing. But I think the greatest value of patient knowledge is when they start reviewing their bills and realize that insurers are making a ton of money but don't even cover the costs of physicians, hospitals and clinics.

However, there could be an adverse effect of this by hospitals only looking at the cheapest supplies and such which could drive down the quality of care.

But I believe that is a chance that needs to be taken.

Also, on a note of your related topic of providing prices to patients.

Wisconsin requires that hospitals post their prices on the web. Minnesota is also proposing that hospitals post their pricing on the web as well.

I have my issues with this because procedures are much more complicated than just one code or one price. Many patients don't realize that each surgery is unique when it comes to time and supplies. You can't just say an appendicitis surgery is going to be $10,000. Each case is unique.

What worries me is that patients are going to start suing because they found a specific price on the web, but their bill was greater than what is posted.

March 04, 2005 2:58 PM  

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