As far as patients are concerned, the verdict is in: Most people think doctors should not take payments from pharmaceutical companies for promoting their products.

In a nationally-representative survey by Consumer Reports of 1,250 adults, more than three-fourths said they would be “very” or “somewhat” concerned about getting the best treatment or advice if their doctor were accepting drug-company money. And 70 percent said doctors should tell their patients about such payments if they are going to prescribe drugs from one of those companies.

The survey, with a sampling error of plus or minus 2.8 percent, was conducted in collaboration with ProPublica’s investigation into promotional payments from drug companies to doctors.

Some patients fear they will end up footing the bill for their doctor’s conflicts. Thirty-six percent of survey respondents said doctors would be “biased enough by the money” to prescribe a drug that was more expensive or no better than others in its class “always or almost always.”

Some doctors, though, disagree that patients care about such payments.

Dr. Thomas Stossel, a Harvard Medical School professor, said such promotional fees are no different than doctors collecting payment after performing tests or surgeries they had recommended. In those cases as well, patients must trust their physician’s judgment, he said.

Stossel helped found the Association of Clinical Researchers and Educators, which asserts that industry relationships with physicians are vital. “When the muckraker reporter calls me and says, ‘I see you got $20,000 from this company,’ I say, ‘Yeah, it’s because I’m good,’” Stossel said.

The new survey’s findings echo two earlier studies, one by Consumer Reports and one by the Pew Prescription Project (PDF), which also found patients are concerned about these issues.

But telling patients about pharmaceutical payments creates another dilemma: What patients should do with the information, said George Loewenstein, a professor at Carnegie Mellon University who has studied how patients and doctors perceive conflicts of interest.

Loewenstein said patients should indeed be alert to financial ties between their doctors and drug companies. Once they are aware of them, it can cause friction in their relationships.

“When physicians inform patients of conflicts of interest, it radically transforms the dynamic,” he said. “All of a sudden if a patient chooses to disregard a doctor’s advice, it’s almost like an allegation of corruption.”

Doctors may be more inclined to prescribe a company’s drug if the patient knows about the conflict, said Dr. Chris McCoy of the National Physicians Alliance. The Alliance, a membership group that does not accept money from drug companies, was founded in 2005 “to restore physicians' primary emphasis on the core values” of the profession.

“It’s sort of buyer beware,” McCoy said. Once the relationship is known, he said, doctors may tend to assume the disclosure resolves any conflicts of interest and therefore give it no more thought.

But Loewenstein said disclosures, if done right, could change doctors’ behavior. He compared the disclosures to a restaurant’s keeping clean once an inspector’s health grade is posted in the window.

Dr. Todd Hess, a Minnesota pain doctor, said that he earned in excess of $300,000 from the industry for speaking and consulting last year. And his patients, he said, don’t care. His speaking engagements abroad enhance his standing in their eyes. “It’s more, ‘What are they saying in Europe? What did you hear in Berlin?’” Hess said.

The survey was conducted by telephone in October by the Consumer Reports National Research Center. Data were statistically weighted so that respondents in the survey were demographically and geographically representative of the entire U.S. adult population.

Other findings include:

• 58 percent thought it was “very” or “somewhat” common for drug companies to pay doctors to give speeches or presentations to other doctors about the effectiveness of their drugs.
• 40 percent said they would not feel comfortable asking if their doctors had accepted payments from the company that makes a drug they prescribe.
• 51 percent said even a payment of $500 or less from a drug company would make them concerned that a “doctor’s judgment might be influenced by the dollars.”

Read the survey here.

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