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Will Disclosure Quiet the Industry’s Critics?. Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009. Why a Doctor Gifts Registry?. Transparency/accountability to patients.
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Will Disclosure Quiet the Industry’s Critics? Peter Lurie, MD, MPH Deputy Director Health Research Group at Public Citizen Presented before The National Disclosure Summit Washington, DC March 5, 2009
Why a Doctor Gifts Registry? • Transparency/accountability to patients
Statement by American College of Physicians “What would my patients think about this arrangement? What would the public think? How would I feel if the relationship was disclosed through the media?” Source: Ann Intern Med 2002;136:396-402
Why a Doctor Gifts Registry? • Transparency/accountability to patients • Restore trust in medical profession • Facilitates kickback investigations • Transparency/accountability to providers • Transparency/accountability to payors • Promotes research (esp. if names provided) • Facilitates journalistic investigations
Uses by Journalists • Investigative pieces by local journalists • Comparisons by specialty • Links to “thought leaders” • Links to state disciplinary actions
Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004 Sources: JAMA 2007;297:1216-23; JAMA 2008;300:1998-2000
Public Disclosure of Pharmaceutical Company Gifts to Physicians, 2002-2004 • High rates of underreporting • Companies report $millions one year, nothing the next • Responses non-standardized • Aggregation by physician and by gift • Exemptions • Samples • Research studies • Limited accessibility • Lack of online submissions or reports • Need to file lawsuit in Vermont • Lack of national standardization
Problems with the Physician Payment Sunshine Act, 2009 • Exclusions • Samples • Research on unapproved products • Gifts totaling <$100 per year • Gifts to other professionals • No payments to organizations • MECCs and PBMs • Patient groups • Hospitals and medical schools • Professional organizations • No judicial review • Low penalties • Intentional non-reporting: cap of $1 million/year
Pharmaceutical Company Promotional Expenditures, U.S., 2004 • Total expenditures • Promotion: $57.5 billion • Research: $31.5 billion • As % of retail sales • Promotion: 24.4% • Research: 13.4% • $61,000 on promotion per physician Source: PLOS Medicine 2008;5:e1
Q: Will Disclosure Quiet the Industry’s Critics?
Q: Will Disclosure Quiet the Industry’s Critics? A: No