Does your doctor get paid to prescribe a drug for you? How to know if there is a conflict of interest

If your doctor prescribes a drug made by a company that you are paid for or have a financial relationship for, I would assume the doctor would tell you. Likewise, if a doctor who earns commission from the device manufacturer is going to implant you with a medical device, say, a hip replacement, I would assume he would tell you.

But there are no laws that require a doctor to tell you about such payments. Many doctors will tell you, of course; it is the ethical thing to do. The vast majority of physicians are ethical and care deeply about their patients. I know that is true; I am married to one. And disclosure of conflicts of interest is a principle of many medical societies and hospitals. But there is little to no oversight or enforcement.

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“More than 615,000 American physicians received some type of payment from pharmaceutical and device companies in 2019 to the tune of nearly $ 2.3 billion”

Potential Conflicts of Interest for Physicians “The more money physicians receive from pharmaceutical and medical device companies, the more brand-name drugs they tend to prescribe,” noted an analysis by the nonprofit media site ProPublica. ProPublica said that even the free lunches that drug company representatives typically provide to doctors’ offices can influence a doctor’s choice of a prescription drug or device to implant. An outspoken psychologist friend told me: “When I choose between recommending Lexapro or Paxil [two antidepressants] for a patient, I usually go with Paxil because the Paxil representative brings the best lunches. “If your doctor was paid hundreds of thousands of dollars to promote or provide a drug or device, human nature dictates that those payments could influence the treatment you choose. That choice might be the best treatment for you, but again, it might not be. Although doctors are not required to disclose these financial connections, pharmaceutical and device companies are required by law to report payments to the government. And you have access to that information, even though most people don’t know about it. What you can learn from the Open Payments site Information about the payments your doctor receives from drug and device manufacturers is in a rather poor area. known from the Federal Centers for Medicare & Medicaid Services (CMS) website: Open Payments. CMS Open Payments data shows that approximately Among one million physicians in the US, more than 615,000 received some form of payment from pharmaceutical and device companies in 2019 to the tune of nearly $ 2.3 billion. You can find any payment or gift worth $ 10 or more on the site; Payments appear in categories such as research, consulting, talks, travel, lodging, gifts, and food. The Open Payments site was recently expanded to include payments made to nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified anesthesiologist assistants and nurse midwives. Also read: Paying Health Care Costs During Retirement The site is the result of the work of Dr. Chuck Rosen, professor and orthopedic surgeon at the University of Calfornia School of Medicine, Irvine. He is also the founder and president of the Association for Medical Ethics. Rosen was dismayed to see his fellow surgeons performing unnecessary surgeries while companies paid them to use devices that were not necessarily necessary. He began writing to US senators about potential conflicts of interest and eventually gained bipartisan support from Senators Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.,) Who championed the legislation that became the Physician Payments Sunshine Act in 2007, part of the Affordable Care Act. But very little effort has been made to educate the public about the Open Payments site. Patients have a responsibility to find out, see if their doctors’ names appear, and speak to their doctors about potential conflicts before receiving treatment or receiving prescriptions. That is difficult to do. I say this from personal experience. As I wrote in my Next Avenue article, “How to tell if a ‘better doctor’ is a good doctor,” I chose a leading plastic surgeon for my preventive double mastectomy to greatly reduce my risk of breast cancer. But he didn’t tell me that he was researching and promoting a device for Allergan, a pharmaceutical company, and lining his pockets with hundreds of thousands of dollars he was receiving from it. I also didn’t know that he planned to use that device with me, without my consent. His experiment failed, causing deformity, severe pain, and requiring three additional corrective surgeries to date. When I found out about Open Payments and investigated my surgeon there, I had already had surgery. The damage was already done. Also read: Food or medicine? The dangerous choice many seniors have to make In my opinion, my doctor’s conflicts of interest (nearly $ 500,000 in drug manufacturer payments) were key to my receiving an unapproved device, not even approved by the Food Administration and Medications. A bill to protect patients That is why I am working with my California State Assemblyman Adrin Nazarian and the Center for Public Interest Law to protect patients by giving them the right to fully informed consent regarding to this type of conflict. Nazarian recently introduced legislation (Assembly Bill 1278) that would require a physician to disclose the source of payments from pharmaceutical and device companies and promote patient awareness of the resources on the CMS Open Payments site. The bill passed its first major hurdle in the Assembly’s Business and Professions Committee by a 13-0 vote and is now heading to the Appropriations Committee. After that, it would be a vote by the full Assembly and then a similar process in the Senate. There is still a long way to go and possibly a bumpy road, but if all goes well, the bill will pass, providing greater transparency and patient protection in California, and perhaps after that, in other states or nationally. . that your doctor must meet the same standards as your financial advisor or real estate agent. After all, if your broker will get commissions from a financial product they recommend, or if your real estate agent has a financial interest in the property you show, or if they receive commissions paid from the vendors they recommend, they should tell you. Demanding this kind of transparency from doctors, say many public defenders, seems like a necessity for a long time. Also read: Americans pay more for prescription drugs than anyone else. Can Amazon Pharmacy change that? Notes David Lind, President of the Heartland Health Research Institute: “Being ethical and transparent with patients and the public about any relationship with third parties, such as pharmaceutical companies, should not be optional in medicine. This information is essential. “In the meantime, it’s up to you to visit the Open Payments site to see if you discover any potential conflicts of interest regarding your health. And don’t be afraid to have an honest conversation with your doctor. Wendy Sue Knecht is an activist for health, former flight attendant, travel bag designer and author of “Life, Love and a Kidnapping: My Pan Am Memory.” Writes on WendySueKnecht. This article has been reprinted with permission from, © 2021 Twin Cities Public Television, Inc. All rights reserved More from Next Avenue: