What do patients want? And why it matters for Sunshine
Roughly two-thirds of patients believe it’s important to know a physician’s ties to a pharmaceutical company, and between 27 percent and 56 percent believe that such ties affect prescribing. Those are some of the findings from a systematic review in the current Archives of Internal Medicine that looked at 20 surveys of patients, research participants and medical journal readers about the impact of financial ties physicians and researchers have with the pharmaceutical industry.
That two-thirds finding – and a study last year suggests that number may be much higher (84 percent wanted their physicians to disclose relevant financial ties to them) – syncs up with the findings of a 2008 nationwide survey (pdf) we conducted: 64 percent felt that it was important to know if their doctor had a relationship with a drug companies. But less than half said they would be likely to ask their doctors about this.
That makes sense. Setting aside the mores around talking about money and mystique associated with the medical profession, the doctor-patient relationship is characterized by an inherent power imbalance: the sick come before one who understands and can treat their condition. So it’s unsurprising that patients are hesitant to ask their doctor whether he or she did a lunch and learn for Lipitor last month.
That’s one reason the Physician Payments Sunshine Act, which passed with national health reform, is so important. The Sunshine Act, which will create a national public website into which drug and device companies must report payments and gifts made to physicians, will allow consumers to access the information they and much of the medical community have deemed relevant to clinical care—without requiring them to obtain it in by asking cold in the exam room.
The authors of the Archives study made this Sunshine connection, highlighting the significance of their findings for those charged with designing and implementing the disclosure database:
[W]e find that, across multiple studies, patients and research participants are able to distinguish between different types of [Financial Ties] as well as the relative importance of disclosure of each. Public reporting systems should be designed to maximize consumer understanding, with an emphasis on clear and straightforward presentation of those FTs that stakeholders care most about.That’s right. But that doesn’t mean it will be easy. As we’ve pointed out here, much-touted voluntary (and often court-ordered) company disclosure data has been hard for researchers and the public to navigate or extract—and each company system is marked by unique loopholes that limit the usefulness of the data.
In an accompanying editorial (subscription required), Eric Campbell, a Harvard researcher who has written extensively on physician-industry relations and served on the Institute of Medicine committee that produced last year’s conflict-of-interest report, wrote:
In order for consumers to use the data, it is clear that the quality of the data that is reported by companies must be improved. The early experiences from Minnesota and Vermont, which have the longest history of making physician-industry relationship data available, suggest that the details are important in making this information useful.Campbell says that means establishing real auditing capabilities, meaningful penalties for non-compliance, and adequate funding to support data collection and reporting.
–Kate Petersen, PostScript blogger