Medical centers reveal doctors' industry pay

Experts foresee a rush of other teaching institutions following suit as political pressure mounts to disclose financial ties to pharmaceutical companies and device makers.

By — Posted Jan. 5, 2009

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The long-simmering concern about how physicians' financial relationships with industry could compromise medical research and education has led two prominent academic medical centers to declare they will shine a light on these ties. But some doctors wonder whether access to this kind of information is something that matters to patients.

Physicians and biomedical researchers affiliated with the Cleveland Clinic and the University of Pennsylvania will have their industry ties publicly disclosed, the organizations announced in December 2008.

The moves come on the heels of three leading drugmakers' announced plans to electronically disclose payments and gifts to doctors of more than $500 a year. That kind of disclosure falls in line with a version of the bipartisan U.S. Senate bill, the Physician Payments Sunshine Act, that would require drugmakers to report in a public, searchable database any physician compensation -- including food, entertainment, gifts, travel and continuing medical education -- exceeding the $500 annual aggregate amount. The AMA supports the Sunshine Act. (See Clarification)

One co-sponsor of the Senate bill is Sen. Charles Grassley (R, Iowa), who also has led a wide-ranging inquiry into academic physician researchers who have received millions in industry payments but allegedly failed to report the income as required by the National Institutes of Health and their universities.

Grassley lauded the Cleveland Clinic's move.

"Patients deserve easy access to information about their doctors' relationships with drug companies," he said in a statement.

The Cleveland Clinic's public disclosure project, which officials there said appears to be the first of its kind among U.S. academic medical centers, is well under way. Physicians' Web profiles now have a section called "industry relationships" that lists any companies in which the doctors have any equity or royalty stake, or from which they received consulting or speaking income of $5,000 or more during the previous year.

About one-quarter of clinic physicians have industry relationships significant enough to be listed, said Guy M. Chisolm III, PhD, director of Cleveland Clinic's innovation and conflict-of-interest management program. He said he first proposed disclosing industry ties in September 2006.

"My point of view was, if we're interested in [innovation] and that's who we are as an institution, it was a mystery to me why we would keep these industry relationships silent," said Chisolm, a cell biologist and vice chair of the clinic's Lerner Research Institute. "There are more benefits than there are downsides to making this information open."

Chisolm consulted with a group of clinic physician leaders for opinions about whether and what precisely to disclose. One decision that came out of these discussions was to avoid listing industry financial ties in isolation.

"We wanted to put this information in context where you see the whole doctor -- where he or she trained, what their specialty is, what diseases they specialize in treating," Chisolm said. "We don't think it's fair to our patients or to our doctors to do otherwise."

The University of Pennsylvania's medical school and health system plan to roll out their public disclosures in the spring. Several other prominent academic medical centers have expressed interest in doing something similar.

Do patients care?

Arthur L. Caplan, PhD, is director of the University of Pennsylvania Center for Bioethics and has been involved in formulating Penn's new policy. "Intrinsically, it's good that people see what the connections are that academic faculty members have with private sector interests," Caplan said. "I'll make the bold prediction that I think the rush to the open-door policy will begin soon."

Howard A. Brody, MD, PhD, said disclosure is "a very good step" but does not obviate other efforts to limit potential conflicts of interest.

"There has to be follow-up," said Dr. Brody, director of the University of Texas Medical Branch Institute for the Medical Humanities and author of Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry.

Whether this voluntary sunshine movement will make the jump beyond academia remains unclear.

William F. Jessee, MD, is CEO of the Medical Group Management Assn., which represents more than 13,500 physician groups, mostly practices of 10 or fewer doctors. He said the MGMA has no policy on whether doctors should disclose financial relationships with industry, and he has not heard of any members pursuing a sunshine plan.

He doubts whether the issue matters to patients. "I'd guess that for about 99.9% of the population, it would never even occur to them to want to know" about industry ties, Dr. Jessee said.

Thomas P. Stossel, MD, said most patients do not care about physicians' financial conflicts. In an e-mail interview, he wondered what the effect on patient care will be.

"When we get done congratulating ourselves on our 'transparency,' will medicine be better off?" said Dr. Stossel, who directs the division of translational medicine at Brigham and Women's Hospital in Massachusetts.

Chisolm said the Cleveland Clinic's next step is to survey a large number of their patients about what kind of industry ties they want disclosed, and whether it has any effect on their relationships with physicians.

"The key, in my head, was to make patients feel like they had the right to ask their doctor about this," Chisolm said. "Whether it will work, we don't know."

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This article stated the American Medical Association supports the Physician Payments Sunshine Act. As a clarification, the AMA supports a widely circulated revised version of the bill that preempts varying state gift-disclosure laws and requires reporting of aggregate payments exceeding $500 annually.

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