More darkness than light will come from physician sunshine act

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Published February 7, 2012 5:00am ET



A new requirement in the Physician Payments Sunshine Act is that pharmaceutical and medical device companies document all their payments to doctors, medical practices and teaching hospitals so these costs can be listed by the Centers for Medicare & Medicaid Services on a public website.

This action will result in unintended (but not unforeseeable) consequences for 21st century medical progress.

The sunshine rules are unclear and complicated — a bad combination. Not only will direct compensation to doctors be reported, but also all other costs of industry-supported physician-related research, consulting and education.

Why this drastic and invasive step? Follow the money. Sunshine supporters hope that physicians, seeing their compensation made public, will curtail their interactions with industry — thus limiting the development and use of “expensive” new products.

Understandably, government and private health insurers want to keep costs stable. And, with prescription co-pays being patients’ most visible expense, they might find this action appealing — for a while — until they see how new treatments and their uptake are seriously delayed.

Collaborations between physicians and industry are fundamental to advancing medicine. Academic physicians have the experience to identify unmet clinical needs, advise on potential new treatments, design and conduct innovative research and, through publications and teaching, bring key information to colleagues and patients.

Physicians and pharmaceutical companies have collaborated on the development of blood pressure-lowering drugs that sharply cut stroke rates; drugs for fighting cholesterol that dramatically reduce heart attacks; and our joint efforts in patients with diabetes have created treatments that protect kidneys and significantly delay or prevent the need for dialysis.

And, beyond the research that brought about these examples of progress, physician leaders have played a central role in educating their colleagues on how best to apply these therapies to their patients.

Conducting clinical research has become so rigorous and sophisticated that those of us who serve as consultants and investigators to industry recognize it as a major commitment or even a primary career path.

Critics see compensation of physicians as evidence of undue influence on medical practice. But doctors, like all professionals, should be paid fairly for their time and work. In reality, companies are so conscious of not appearing to overpay doctors that they employ stringent “fair value” scales to set fees for research, consulting and teaching activities.

The truth is that physicians who are busy with these activities are not as well-rewarded as their fellow specialists in full-time clinical practice. Adding to this remunerative divergence is that a key part of research, writing articles for publication, can take weeks of work — usually unpaid so as to avoid any suggestion of bias.

The Sunshine Act will create troubling misconceptions for and about physicians. Payments reported for physicians by industry will likely include funding they didn’t personally receive nor will they take into account costs incurred by these physicians in paying their own staff and covering overhead expenses.

Doctors involved in industry-supported research and education will get discouraged and frustrated explaining these complexities to an audience already biased and sated by sensationalistic media reports of physicians “on the take.”

Dr. Michael Weber, a former president of the American Society of Hypertension, is editor in chief of the Journal of Clinical Hypertension, professor of medicine at State University of New York Downstate College of Medicine, chairman of the Center for Medicine in the Public Interest, and a member of the Association of Clinical Researchers and Educators.