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Will the world's best students flock to China to study?
By Daniel Luzer
Memo: The way forward on health care reform in 2010.
By Steve Benen
A dark legacy of the Vietnam War is creating a whole new set of problems.
By various authors
What are the presidents grass roots good for?
By Charles Homans
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July 17, 2009
Sunshine
Here's an interesting catch by Merrill Goozner:
"The House bill would create an internet accessible database that includes all health-related payments to physicians by corporations including gifts, food, or entertainment; travel or trips; honoraria; research funding or grants; education or conference funding; consulting fees; ownership or investment interests; and royalties or license fees. If I'm reading the bill correctly, it says anything over $5 must be reported. (From pg. 635 of the bill.)"
I believe the relevant section of the bill is 1451, and it does seem to say that. This is really good news. There is a lot of money sloshing around in health care. There are advisory boards, speakers' bureaus, conferences conveniently held in beach resorts, educational (and "educational") events, dinners courtesy of drug companies, gifts, etc., etc., etc. And that's not counting things like industry-sponsored research.
A lot of this is just marketing, sometimes disguised and sometimes not. Making it public would have two very good effects. First, and most obviously, it would allow people to discover any conflicts of interest that their doctors might have. Second, it might shame people. If you're an "opinion leader", or in some other way a good catch for a company, it's possible to get very considerable amounts of money from these sorts of things. If it came out that some doctors were getting, say, hundreds of thousands of dollars, not for doing research but for various marketing-esque activities, I suspect that those doctors might become less greedy.
And that would be a good thing. Most people don't think that they would allow their judgment to be corrupted by something like a fancy dinner with a flattering sales rep, or even an all-expenses paid trip to an industry-sponsored conference at Waikiki. But there's a fair amount of research that shows that accepting a gift from someone does affect your judgment, whether you're aware of it or not. (Why else would pharmaceutical companies give all these gifts?)
Making these gifts public is an excellent thing. Good for the House committees for writing it into their bill.
—Hilzoy 7:25 PM
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It would be even better to have this same kind of reporting by members of congress.
Posted by: karen marie on July 17, 2009 at 7:30 PM | PERMALINK
Who reports -- donor or recipient?
Posted by: Davis X. Machina on July 17, 2009 at 7:53 PM | PERMALINK
Davis: Donor reports, but the reports include the recipient's name, which is made public.
Posted by: hilzoy on July 17, 2009 at 7:55 PM | PERMALINK
Vy good. The donor's got the staff...
Posted by: Davis X. Machina on July 17, 2009 at 8:01 PM | PERMALINK
Unless the government requires SSN (and that could be a violation of the Privacy Act) then when you look up Doctor Kim you will see 1000 names. What requirement is there for the donor to ensure the identiy is correct. Also, is it specific to physicians or all healthcare workers.
Posted by: superdestroyer on July 17, 2009 at 8:02 PM | PERMALINK
Hilzoy, your substantive, thoughtful and informative articles will be missed on this site.
Posted by: SecularAnimist on July 17, 2009 at 8:57 PM | PERMALINK
Once a month I take a relative to her doctor's appointment and wait for about an hour or so in the parking lot.
It's astonishing how many sales reps visit one doctor in an hour--usually I count as many as 8.
All drive late-model vehicles.
Posted by: h on July 17, 2009 at 9:06 PM | PERMALINK
My academic health center now bans *all* gifts of anything of value from anyone doing business with the university and also has an increasingly tough conflict of interest policy (for things like advisory boards, etc.). Definitely part of a very good trend.
Posted by: Christopher on July 17, 2009 at 9:58 PM | PERMALINK
Hilzoy, we are going to miss you. Thanks for your wonderful contributions.
Posted by: Benjamin on July 17, 2009 at 10:02 PM | PERMALINK
Thanks for, with Steve Benen, making this the best political blog on the Web. I'll miss you.
Posted by: hells littlest angel on July 17, 2009 at 10:06 PM | PERMALINK
Jesse Unruh, quoted by Ezra Klein:
"...if you can’t take their money, drink their whiskey, screw their women, and vote against ‘em anyway, you don’t belong in the Legislature."
Posted by: steverino on July 17, 2009 at 10:36 PM | PERMALINK
They've incorporated a bill that's been introduced a couple of years in a row but never gained any traction. Basically, if drug company pays a doctor to speak at a conference, or a rep. from a replacement joint manufacturer brings doughnuts to a doctor's office, they have to document and report it. A few states already have these sorts of laws on the books (Mass. is the latest).
If it came out that some doctors were getting, say, hundreds of thousands of dollars, not for doing research but for various marketing-esque activities, I suspect that those doctors might become less greedy.
This is already illegal and companies that do it wouldn't report it anyway. If this passes it will mean the company can be penalized for the illegal arrangement AND failing to report it. Sadly, the money these companies earn for things that are blatantly illegal (like your example) far outweighs the amount of any penalties (that's why the same companies keep getting hit, they don't care). You won't see this sort of thing really decrease until they start dragging the doctors involved into court and/or some corporate exec goes to jail.
/Healthcare policy wonking.
Posted by: The Answer WAS Orange on July 17, 2009 at 11:32 PM | PERMALINK
I have a feeling this is a bluff. It's there to pressure doctor organizations by scaring the bejeesus out of their members, and this section or another like it seems to have persuaded the AMA to play along. If passed, this bill would be like forcing doctors to wear their underwear outside their labcoats. So many of them have cushy deals of one kind or another with Big Pharm and other suppliers, insurers, fellow doctors, etc.
I have a feeling it'll be pulled or shot full of loopholes before the reconciliation process is done with the bill, but the fact Democrats can get it through committee gives them a strong negotiating position. If this is the Chicago Way, more of this please.
Posted by: Jordan on July 18, 2009 at 12:05 AM | PERMALINK
superdestroyer: if you check the bill, you'll see the following:
"(1) IN GENERAL- The Secretary shall establish procedures to ensure that, not later than September 30, 2011, and on June 30 of each year beginning thereafter, the information submitted under subsections (a) and (b), other than information regard drug samples, with respect to the preceding calendar year is made available through an Internet website that--
(A) is searchable and is in a format that is clear and understandable;
(B) contains information that is presented by the name of the applicable manufacturer or distributor, the name of the covered recipient, the business address of the covered recipient, the specialty (if applicable) of the covered recipient, the value of the payment or other transfer of value, the date on which the payment or other transfer of value was provided to the covered recipient, the form of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(ii), the nature of the payment or other transfer of value, indicated (as appropriate) under subsection (a)(1)(B)(iii), and the name of the covered drug, device, biological, or medical supply, as applicable;
(C) contains information that is able to be easily aggregated and downloaded;"
(there are more sections, but these are the relevant ones.) As they will have business addresses for the various Dr. Kims, it should be easy to find your particular Dr. Kim.
See how easy?
Posted by: hilzoy on July 18, 2009 at 12:14 AM | PERMALINK
Bon Voyage. And would you please pack and take Pat Bucannan (the bald-faced liar won't-go-away-bird) with you?
Posted by: chopin on July 18, 2009 at 1:51 AM | PERMALINK
Oh, dear, there seems to be a bit of naivete on this thread.
If a doctor is speaking about the effectiveness that a drug at conferences, and it just so happens the drug's manufacturers are footing his bill, that is not, AFAIK, illegal.
But maybe it should be.
Posted by: inkadu on July 18, 2009 at 7:05 AM | PERMALINK
Yessss! Now watch for who opposes it!
Posted by: N e i l B on July 18, 2009 at 10:54 AM | PERMALINK
Too bad that the legal profession will not adopt the same rules as the medical profession such as not being paid for referrals or the ability to drop a client due to the inability to pay.
Posted by: superdestroyer on July 18, 2009 at 8:11 PM | PERMALINK
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