As part of the Affordable Care Act, pharmaceutical company payments to doctors will become public information starting in 2014. But a slice of those disclosures is already available, and the impact of transparency is being felt across New Hampshire.
In the last four years, New Hampshire doctors and nurse practitioners have taken in $5.8 million in money from drug companies.
But in 2012, for the highest earning doctors, there was a noticeable decline. In fact, every one of the top 10 recipients in the state saw his or her total compensation go down or hold flat last year.
The numbers come from ProPublica, an investigative journalism group.
Pharmaceutical companies can pay doctors for a variety of activities: from research and consulting to speaking engagements, meals and travel reimbursement.
“You know, medicine has evolved as a very complicated business,” says Dr. Rebecca Neal, Chair of the Ethics Committee at the New Hampshire Psychiatric Society.
“And it is increasingly a business, whether we like it or not.”
A Changing Industry
The payments are all perfectly legal, but Neal says it’s the perception of a doctor working hand-in-hand with a drug company that troubles some.
That relationship, though, is changing. And big health care employers are one reason.
“The idea that it is a real or perceived conflict of interest is really important to us,” says Rick Adams, spokesman for Dartmouth Hitchcock.
“And we have to make sure there isn’t even the perception of a conflict.”
When NHPR first reported on this topic in 2009, Dartmouth Hitchcock allowed its staff to speak on behalf of drug companies at lectures and gatherings. Last year, that changed. The medical school now bans drug reps from campus, and while professors can still consult and do research, they can no longer market drugs at what the industry events called speaker’s bureaus.
Psychiatrist John Miller, who isn’t affiliated with Dartmouth, doesn’t like the term ‘marketing’. He’s the state’s top recipient and according to ProPublica, one of the highest compensated doctors in the country, earning more than $700,000 speaking on behalf of drugs including Seroquel, Zoloft and Viagra.
Miller calls himself a liaison, not an ad-man.
“Everybody in that room knows I’m getting paid for that talk, and they are coming to the talk knowing that it is being sponsored by the company of that drug. It’s all right there out front, it is all wide open.”
Miller works part time at Seacoast Mental Health in Exeter, which doesn’t have a policy against accepting payments. He’s on the road three days a week, delivering roughly 100 presentations a year.
“I earn the money that I make,” says Miller. “I work hard, I put a lot of time into it, I’m away from home a lot, I travel, and it’s stressful. It looks like a big number, but if you were to look at my time, and how I spend it, and you were to look at other physicians who do clinical work all the time, they are up there with me, or I’m trying to catch up with them.”
Calls For Disclosure
Miller stresses that he informs patients when he recommends or prescribes a drug he also pitches.
But the possibility of bias--of doctors over-prescribing a drug they are paid to promote--is a loud argument against any form of payment, even if it is disclosed.
“There’s overwhelming evidence that the gifts, the travel grants, the support for continuing medical education, all have an effect on which drugs doctors prescribe for their patients,” says Danny Carlat, with the Pew Charitable Trusts, which advocates for complete transparency in the field.
But Dr. Miller points out that he only liaisons for drugs that he believes in, so it follows that he also prescribes them.
Miller also publishes each of his relationships on his website.
The Affordable Care Act will extend that disclosure to all doctors.
David Grande researches the issue at the UPENN School of Medicine.
He says that additional sunshine could be a black eye to the industry, forcing a shift in tactic.
“Well, I don’t think marketing to doctors is going to go away, by any means. The question is, how will it change?”
Grande says maybe more online promotion, or one-to-one marketing.
No matter what direction it takes, the industry still has time to plan. The provision doesn’t go live until September 2014.