Is Your Doctor on Big Pharma's Dole?

October 9th, 2014  |  Source: HuffPo

A signature theme of my new bookUnaccountable is a staggering decline in trust in an array of institutions: banks, Congress, the media, you name it, since the 1970s. But in one area, trust has grown. Nearly 70 percent of Americans polled late last year thought their doctors rated high or very high for honesty and integrity. That's 22 points higher than the clergy. (If you're a lobbyist, don't bother looking.)

Do doctors deserve that trust? Perhaps not entirely, according to ProPublica, the New York Times, and my own analysis in Unaccountable. Pharmaceutical companies engage in direct lobbying of lawmakers, but the focus of my book is the newer, unconventional, and typically more insidious path to influence, in areas that extend far beyond health to nearly every important policy area. Big Pharma's path is through painstakingly chosen and highly paid-and-perked doctors and researchers.

An elite few who take large sums from Big Pharma very likely sway decision making by countless other physicians, who might not even know they are getting a choreographed, yet subtle, sell-job. But even when these elite few can be named, it's not clear whether they can be shamed: disclosure alone can often be a mere "performance" of accountability.

ProPublica, which has been covering the story for years in its Dollars for Docs series,began examining a government database that went live last week, as mandated by the 2010 Physician Payment Sunshine Act. ProPublica found that from August to December 2013, drug and device makers channelled $3.5 billion to more than a half million medical professionals and around 1,360 teaching hospitals.

At least $350 million was earmarked for speaking and consulting gigs. Ethicists looking at the issue told the New York Times that they focus closely on speaking and consulting because "these relationships can influence prescribing behavior and negatively affect patients, especially when such ties are lucrative."

Another statistic stands out. Of the 32,000 doctors or researchers named in the database as having received Big Pharma money, the average took in less than $2,000. It was a tiny group of just 130 who earned more than $100,000. Time Magazineflagged a super-elite within that subset: 18 doctors who accepted more than a million dollars each from top drug and device companies.

Some of these medical professionals may well be what the industry calls Key Opinion Leaders or KOLs, which have proliferated nearly worldwide since the end of the Cold War. (Google KOLs, and you'll find a whole cottage industry that will help drug and device makers identify the best medical "thought leaders.")

Often these experts are high-status physicians or medical researchers who sport impressive credentials; they may be affiliated with top medical schools, journals, and professional associations. KOLs often garner more in industry consulting fees than from their "day job." And yet it is that day-job image as an incorruptible, oath-taking doctor or researcher that lends them weight. The job of these opinion leaders is to convince fellow professionals that a particular company's product is most effective. "The KOL is a combination of celebrity spokesperson, neighborhood gossip, and the popular kid in high school," observed Carl Elliott, University of Minnesota bioethics ethics professor, in the Chronicle of Higher Education.

The physician who sits on the board of a major journal or a medical specialty association can act as a gatekeeper for the narrative. Your physician hears the talk, reads the journal, all the while listening to the "authority"--the KOL.

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