Industry Payments to Doctors Continue Despite the Sunshine Act Disclosures
(Thursday, November, 2020] Manufacturers paying prescribers to encourage preferred prescriptions is an unethical practice barred by most codes of ethics since it is effectively bribing physicians to influence their medical decisions. The Sunshine Act, 2010, requires manufacturers to disclose all payments made to physicians in any form with an intent to discourage such practice. The law created a searchable online public database containing physician payment information whereby patients can find out if their physicians are getting paid to write their prescriptions. Although the law does not explicitly prohibit payments to prescribers by manufacturers, it intends to create a process to discourage by “shaming via disclosure” of such manufacturer-prescriber financial relations. And it has worked, it seems. Searches on the public database show that while manufacturers still pay prescribers, mostly during marketing presentations or as consultants, most such payments are smaller which presumably would not practically influence a medical decision. In a survey of cardiologists related to an implantable device, it was found that although 94% of the cardiologists received some payment from manufacturers, 43% received less than $1000 per year, and another 39% received between $1000-10,000 per year. Although $10,000 seems like a significant payment to a physician by a manufacturer, but in the context of cardiac surgeons, most of who make a lot more than $10,000 per year, the amount of payment would be considered small enough to avoid financial conflict of interest in their decision to use a given implantable medical device. Payments to physicians by manufacturers are not a clear black and white issue. Manufacturers need to communicate with prescribers for which they need to create some avenues to build a relationship. Small payments such as inviting to paid lunch or providing a reasonable honorarium to compensate for time are not the kind of payments the Sunshine Act intended to stop. The Act intended to stop the blatant bribing of doctors by manufacturers, common in the 90s. It seems the Act is getting the desired effect. Only about 2-4% of the physicians received more than $25,000 per year from manufacturers and you can be assured that even those payments were supported by robust justifications. The Sunshine Act is working. |
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