Journalism in the Public Interest

Consumer Reports: Most Patients Worry About Pharma Payments to Doctors

A Consumer Reports survey has found that patients say they would be concerned about the quality of care they receive from a doctor who is paid to promote a drug. And they said they want to know about such payments.

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.

I looked up my neurologist and he is on the list.  I know that he thinks very highly of the drug companies, and it has made me very skeptical of any drug he presents to me as a migraine preventative.  I have been hospitalized 4 times due to drug reactions to drugs he has prescribed for me, causing me to not take any drugs for my severe, chronic migraines as I no longer trust the drugs that come out.  They seem to do more harm than good these days, being pulled left and right off the market because of severe effects causing problems up to and including death!!  I no longer trust this Doctor to have my best interests at heart.  It makes me very sad, as I was one of his first patients when he started his practice.  He has also lost his privileges to practice at either of two hospitals in his town.  I really appreciate this report.

Students with disabilities I work with as well as friends or acquaintances have been diagnosed with conditions for which they are prescribed prescription drugs.  They tend to work well enough.  Lo and behold, the doctor abruptly changes the prescription seemingly because of pharmaceutical influences.  Then side effects take over.  The original problem is less well helped by the new drug and the student or other person confronts a whole new set of problems.  So it seems to go with “swamping of a pt. with new medicines.”  This is not quite the problem of patients
discussed here but experience cited here directly or indirectly reflects physicians’ reliance on drug companies’ recommendations to doctors

Richard Carpenter

Oct. 21, 2010, 12:19 p.m.

If you do not wish to change your meds because your doctor received a payoff, say so.  If your doctor does not get the message, say so and find a new doctor. For the shy, follow this script:
Your Doc:  I know you like your medication but I think you should try this new one one.
YOU: I don’t think so; I want to stay with what I’m using now.
[ repeat this exchange several times]
If your doctor gets the message fine if not, say
“OK, I think I need a new doctor; have a nice day.”
and leave.
Easy, no?  No doctor in the US will try to stop you physically and if he did you would call one of those slimebag malpractice attorneys who advertise on TV.

That some doctors don’t see any problems with such payments as a potential conflict of interest says volumes about why publicizing this topic is important. Your doctor may not tell you that he or she takes pharma payments.

Thank you for this report. Propublica’s efforts are in the best tradition of fair, detailed investigative journalism.

I believe in total transparency when it comes to the sunshine law. Patients also need to be aware of Pay for Performance tactics by insurance companies.  As a consumer and a patient I do not want my doctor prescribing me a generic because he is going to get an extra dollar in his pocket.  Thousands of dollars are being paid to large clinics who practice this way.  This should also be available for all to see. Because of the $4 meds these prescriptions are getting more difficult to track, which some companies are trying to demand that you use your insurance sometimes resulting in a higher co-pay.

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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