Conflicts of Interest—The Hidden Cost of Free Lunch for Doctors

by Steve S. Ryan, PhD, September 2016. Updated May 2017

Few people in the U.S. today are shocked or scandalized that the Drug and Device Industry (DDI) basically bribes doctors and hospitals to prescribe their drugs or use their equipment. It’s so commonly done that we take it for granted.

In the U.S., in general, it isn’t considered unethical or immoral for doctors to accept payments or favors from the Drug and Device Industry (DDI). Nor is it illegal.

May 2017 Update: Pharma companies signed onto a set of policies, the PhRMA Code of Conduct, regarding the way they would interact with physicians which is basically a code of conduct. Read the policy.

Here are some major points or changes in how sales reps should conduct themselves:

• No Personal Gifts
• No Entertainment of Recreational Events
• No Branded Products
• “Modest” Meals are OK – in context of education

Many academic centers now enforce stricter policies limiting access of pharmaceutical reps to physicians, and strict punishments or fines for rule violations. [Medpage Today, May 4, 2017])

U.S. patients can now simply type in our doctor’s name in the Open Payments Database and see how much they are being paid by the DDI and what conflicts of interest they have.

Thanks to the Sunshine Act (a provision of the U.S. 2010 Patient Protection and Affordable Care Act), the DDI must report when they make a payment to a doctor for meals, promotional speaking or other activities.

This data is available at https://projects.propublica.org/docdollars/ Just type in your doctor’s name. See also, OpenPaymentData.CMS.gov and the ProPublica Dollars for Docs project.

Influencing Doctors’ Prescriptions for the Price of a Meal

In a recent JAMA Internal Medicine report (DeJong, C., June 2016), the authors compared meal payments to doctors with the drugs they prescribed to Medicare patients.

Not surprisingly, they found that physicians who accept free meals from a drug company are more likely to prescribe that company’s brand name drugs rather than cheaper (and usually more proven) generic drugs. This study only focused on physicians who received meals.

Even doctors who accepted only one free meal were more likely to prescribe the brand name drug. Doctors who accepted four or more meals were far more likely to prescribe brand name drugs than doctors who accepted no meals. Furthermore, doctors who accepted more expensive meals prescribed more brand name drugs.

In another related JAMA Internal Medicine report (Yeh, JS, June 2016), researchers found similar evidence that industry payments to physicians are associated with higher rates of prescribing brand-name statins.

Steer Clear of Conflicts of Interest

The publication, Bottom Line Personal, offered words of wisdom on this subject.

“Studies have found that when there is a conflict of interest, it is almost impossible for even well-meaning people to see things objectively.”

Dr. Dan Ariely of Duke University described how, if a doctor must choose between two procedures, they are likely to pick the one that has the better outcome for their bottom line.

“That doesn’t mean the doctor is unethical…it just means he is human. We truly seem to not realize how corrosive conflicts of interest are to honesty and objectivity.”

He advocates that we steer clear of people and organizations with conflicts of interest “because it does not appear to be possible to overcome conflicts of interest.”

Conflicts of Interest: Be Suspicious of Doctors

Doctors are only human. If a drug rep does them a favor, of course they will be inclined to favor that rep’s drug.

But be suspicious if your doctor tells you:

• to take an expensive new drug
• to just “live with your A-Fib”
• insists that catheter ablation is too dangerous or unproven
• that A-Fib can’t be cured
• that you have to take drugs for the rest of your life

If this happens to you, RUN and get a second opinion (and even a third opinion).

Conflicts of Interest: Be Suspicious of Health/Heart Websites

When I attend talks at most A-Fib conferences, the first slide a presenter shows is often a list of their Conflicts of Interest.

But this is not required of websites! Health/Heart websites are not required to be transparent and reveal their conflicts of interest.

Whenever you visit a health/heart website, ask yourself: “Who owns this site?” and “What is their agenda?” (Hint: Check their list of “sponsors” and follow the money!)

Drug Industry Owns or Influences Most Heart/Health Web sites

The drug and device industry owns, operates or influences almost every health/heart related web site on the Internet!

For example, did you know that the drug company Ely Lilly partially owns and operates WebMD, the Heart.org, Medscape.com, eMedicine.com and many other health web sites?

The fact is that most health/heart web sites are supported by drug companies who donate most of their funding. Consider how that may affect the information they put on their web sites―they’re not going to bite the hand that feeds them.

About A-Fib.com: Read A-Fib.com disclosures on our website and check
A-Fib.com’s 990s at GuideStar.org.

Be Suspicious of A-Fib Info on the Internet

Video: Buyer Beware of Misleading or Inaccurate A-Fib Information.

In our crazy world, you can’t afford to trust anything you read on the Internet.

At one time I tried to keep track of all the mis-information found on various A-Fib web sites. When we’d find something wrong, we would write the site. I don’t think we’ve ever received a reply. Finally, we gave up. (See my video: Buyer Beware of Misleading or Inaccurate A-Fib Information.)

Many web sites put out biased or mis-information. Be skeptical. You can tell if someone is trying to pull the wool over your eyes. Truth will out. If you feel uncomfortable or that something is wrong with a site, it probably is. When you find a good site, the truth will jump out at you.

In today’s world, you have to do your own due diligence. You know what makes sense and what doesn’t.

For more, see my article: EP’s Million Dollar Club—Are Payments to Doctors Buying Influence?

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