Perhaps what is needed to keep these in check is to make all the undisclosed payments to come to light. To this effect, a national sunshine law that takes effect in 2013 would require all pharmaceutical companies to disclose the money that they are paying doctors. However, social psychological theories suggest that informing the public about how much doctors are receiving from drug companies might actually cause more doctors accept the incentives from drug companies. By exposing the widespread nature of a problem, doctors may become influenced to think that accepting financial incentives from drug companies is a common practice and therefore acceptable. Furthermore, doctors who disclose to their patients that they are receiving benefits from drug companies become more biased in their recommendations to their patients, and ironically, patients are also more likely to trust them. This casts doubts on whether the sunshine law would really help to reduce the negative effects of the doctors' bias on patients.
To add to this drama, an independent investigative journalism group, ProPublica, has recently put up a searchable database on their site. This database, “Dollars for Docs”, allows anyone to check how much money their doctors are being paid by drug companies. Would this then worsen the effects of biased prescriptions? It appears so. While exposure of statistics and high-profile case by news agencies would only cause doctors to get a general sense of how many doctors are getting incentives, “Dollars for Docs” allows the doctors to actually find out how much their peers are getting paid. This acts as an even stronger social proof, since a doctor would likely be able find someone he/she knows as a decent person who is receiving much more money than he/she is. This may cause even more doctors to accept incentives from drug companies.
Does this mean that ProPublica is doing a disservice to the public? Not necessarily. It allows the government to see the problem as what it is, and tackle it accordingly with the right kind of legislation and enforcement. If government officials are given to authority to act on this information to impose penalties on doctors who receive incentives, then disclosure is the right step to go.
1 comment:
This is an interesting dilemma: on one hand, we want to increase transparency since people have a right to know if doctors are receiving money for the drugs they prescribe. On the other hand, increasing transparency could make these financial relationships more permissible and commonplace. Carl Elliot seems to think that writing favorable journal articles for a drug and giving lectures in support of it is wrong. He wants to abolish the practice, but you believe total transparency can better address the incentivization. You mention that a database like Pro Publica is useful since government officials can use this information to track down doctors who receive incentives.
But I think there is a more fundamental assumption here that I do not agree with: is the practice of receiving money to speak at a conference for a particular pharmaceutical company, or to promote that company ethically wrong? Are incentives allowed? There’s no need for government officials to track down any doctors if the practice itself is legal and well-intentioned. Furthermore, I do not think Pro Publica is particularly necessary. The incentivization of drug marketing is only wrong if it violates principles of social beneficence. Therefore, physicians need to make their own judgments regarding the effectiveness of a drug, and that sense of morality should drive the issue, rather than the practice of receiving money itself. Because big pharma can gain just as much from doctors prescribing their medication as doctors can from promoting it, both groups can mutually benefit from a free-market system. Furthermore, both groups control it. Patients do not need to worry about losing out on the more effective drug because their doctors are under the sway of Big Pharma; doctor approval and recommendation is what leads to the profit of a drug company, in the first place.
In short, transparency is always ideal, but before we take up arms against a very normal, capitalistic model of medical practice, we should assess the situation objectively.
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