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Brian Rank, M.D. , member of the Quality committee
Editor's note: This article appeared in the Pioneer Press September 22, 2007.
Should Minnesotans be concerned about the influence drug companies have on the prescribing behaviors of their doctors?
As physician leaders whose organizations collectively serve nearly 2 million Minnesotans, we believe the answer is yes. Individually and together, we've been working on policies to ensure that physicians in our organizations make prescribing decisions based on what is best for their patients and not influenced by relationships with industry.
We believe our patients and community deserve a higher standard of accountability and transparency from their physicians and health care systems than ever before in order to maintain the trust that is essential to healing relationships.
A report last March in the Journal of the American Medical Association highlighted the issue of drug company payments to Minnesota physicians. The report focused on Minnesota because our state requires drug companies to provide an annual report of payments to physicians.
The JAMA report analyzed drug company payments to Minnesota physicians from 2002 through 2004, including payments for expenses such as research, consulting, speaking engagements, travel and continuing education. According to the report, these payments totaled more than $31 million over three years, with only a quarter of drug companies providing information.
The report immediately drew broad national media attention. A subsequent series of articles in the New York Times, and coverage in the St. Paul Pioneer Press, continue to keep the issue of inappropriate drug company influence on physician prescribing decisions in the headlines.
For us, the JAMA report represents an important step toward making health care decisions more accountable and transparent for everyone. Our work on this issue has required us to take a thoughtful approach to understanding which interactions between drug companies and physicians are appropriate and which may be, or perceived to be, in conflict with the interests of our patients.
While it is difficult to know with precision where the line should fall in each and every case, we are adamant that a physician's recommendation to a patient must reflect best medical evidence and be without influence from his or her relationship with a drug company.
More work remains, but we are making good progress. For example, our organizations are in various stages of requiring physicians to disclose conflicts of interest and income from industry relationships and in some cases seek prior approval for industry relationships.
Our organizations have also either prohibited or restricted the longstanding practice of pharmaceutical "sampling" (handing out free drug samples) within our facilities.
As a group, we strongly support reforms that would increase transparency by requiring the drug and medical device industries to do comprehensive, annual, standardized public reporting of manufacturer payments to physicians.
We also believe industry can play an important role in reform by providing unbiased information to physicians and the public about products. Currently, drug companies and device manufacturers sponsor "talks," sometimes at lavish locations, that introduce products to medical practitioners. Physicians often receive generous payments for attending these talks or for being "expert" presenters.
Tactics like these undermine the trust patients have in physicians to be unbiased advocates for their health. To enhance patient trust, we propose that industry be responsible for funding unbiased, public and professional education about products. This could be accomplished through unrestricted grants from manufacturers to health care organizations, educational institutions or consumer organizations, like the Consumer Union. These grants would help underwrite the cost of providing independent, evidence-based information on the appropriate use of drugs and medical devices.
Industry also has a responsibility to increase funding for independent research on the safety and effectiveness of products after they come to market. Independent institutions, such as Minnesota's Institute for Clinical Systems Improvement, could conduct this research with strict protections to prevent inappropriate manufacturer influence on the results. Funding for this research could come directly from the millions of dollars industry now spends annually on promotional activities and payments directed at Minnesota physicians.
The traditional relationship between industry and physicians has put the health care system at an ethical crossroads. Inherent in that is an opportunity for our state to lead – as we have so often in health care – in developing our own workable, evidence-based model for others around the nation to copy.
We are keenly aware of our patients' right to expect physician relationships with industry to have their best interests at heart. Our organizations will continue to work,collaboratively and individually, to ensure that that's exactly what we deliver.
Brian Rank, M.D., is medical director of HealthPartners Medical Group. He writes on behalf of the Physician Leadership Policy Forum, a group of physician leaders from Allina Hospitals and Clinics, Children's Hospitals and Clinics, HealthEast, HealthPartners, Hennepin Faculty Associates, Fairview Health Services, North Memorial Medical Center, Park Nicollet Health Services and University of Minnesota Physicians. His e-mail address is brian.h.rank@healthpartners.com.
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