Thursday, December 19, 2013

The virtues of disclosure

For years, pharma firms have paid doctors to speak on behalf of their products at professional conferences and meetings, in the understanding that it is potent tool to persuade doctors. For years, this practice has been criticized on the grounds that it unduly influences the information doctors give each other and the possibility of prescribing drugs inappropriately (or for the wrong reasons). But the practice was and is legal. Now, with the Obama administration’s health care law, such practices and payments by pharmaceutical companies must be made public next year. And apparently that has made Glaxo announce, this week, that by 2016, they will no longer pay health care professionals to speak on its behalf “to audiences who can prescribe or influence prescribing.” Glaxo will no longer provide direct financial support to doctors to attend medical conferences, a practice that is prohibited in the United States (through an industry-based ethics code) but still allowed in other countries. According to the NYT's report (here), a handful of drug makers are adopting similar actions for several reasons, "including concerns about the reaction to the required disclosure of such payments that will begin next fall under a provision of the health care law."
Glaxo also announced it will extend its new integrity initiatives to its global business: for example, beginning in 2015, it will no longer compensate sales representatives based on the number of prescriptions doctors write. Instead, its sales representatives worldwide would be paid based on their technical knowledge, the quality of service they provided to clients, and the company’s business performance.
These initiatives may help improving the relationships between pharma firms as physicians. Dr. Raed Dweik, the new chairman of the conflict of interest committee at the Cleveland Clinic is quoted saying that he, as a physician, often meet with the pharma firm's sales reps and that they come in armed with information about he that he does not even know, like the number of prescriptions he has written for the drug company’s product: “I feel that’s not really a comfortable interaction to have.”
My colleagues, however, are not so confident about the potential of disclosure requirements. You can check the work by Daylian Cain about how disclosure helps conflicted advisors and harms their advisees. For example, he found that advisors feel comfortable giving more biased advice, but advisees do not properly adjust for this and so fail to discount biased advice (here).

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