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Sunshine Isn't So Bright After All


A recent article in MedPage Today reported that most physicians have a favorable view about gifts from pharmaceutical and medical technology companies.'  What do we, as patients or potential patients, think about that?

Well, it's hard to form an opinion when we don't know everything that is going on between doctors and companies.'  An article published in 2009 in the International Journal of Health Services found that our awareness that our doctors receive gifts, varies, depending on what kind of gift it is.  For example, 94 percent of us know about free drug samples but only 19 percent of us have heard about golf tournament fees being reimbursed by companies.

So how do we feel once we are informed of this gift giving practice? Only four percent of us approved of reimbursed golf tournament fees and 12 percent of us approved of physicians receiving dinner from pharmaceutical companies.'  Around half of us approved of drug samples, pens, and medical books as gifts.

When I see a pen in my doctor's hand with a drug company logo on the side as she writes my prescription, I wonder what other interactions between her and the drug company rep occur. I am concerned with how these interactions influence the medication she prescribes and the cost of that medication.  Further, I know that this relationship between the pharmaceutical company and potentially other medical technology companies does not stop with a pen.'  Companies spend $25 billion each year marketing to doctors.

This problem hasn't gone unnoticed. The Physician Payment Sunshine Act within the health care reform bill requires drug and medical device manufacturers to publically report payments made to physicians and teaching hospitals. Payments include cash compensation, food, entertainment, travel expenses, consulting fees, honoraria, research funding or grants, education or conference funding, stock or stock options, ownership or investment interest, royalties or licenses, and charity contributions. Physicians' names, address, value, date, and form of the payment will be available for the public in an online database starting by September 30, 2013.

I think this is a step in the right direction, but I fear it won't really benefit us. Is the expectation that we will now conduct research on possible conflicts of interest of our doctors prior to each visit?

And having done so, what will we do with this information?  Should we not consult a physician on the grounds that he or she has received gifts from many drug companies? Personally, I'd feel intimidated to initiate this conversation with my doctors and fear it would erode our relationship.

From our perspective, it looks like the doctors get all the pens and the free lunches, while we get to do all the research and risk our relationship if we raise questions. It turns out that the Sunshine Act isn't so bright after all.

How do you feel about gifts given to your doctor from drug and medical device companies?

More Blog Posts by Sarah Jorgenson

author bio

Sarah Jorgenson, MA, MS, is currently a medical student in Chicago. Previously, she served as a communications and research associate for the Center for Advancing Health (CFAH) and as a contributing writer for its Health Behavior News Service. She graduated with an MA in Bioethics, Humanities and Society from Michigan State University (MSU), where she worked as a research assistant for Dr. Margaret Holmes-Rovner with the Center for Ethics and Humanities in the Life Sciences. She served on the research team for CFAH's Snapshot of People's Engagement in Their Health Care, contributed to a Cochrane Review update, and participated in research on shared decision making for patients with coronary artery disease. She also worked as a receptionist at MSU's Child Health Care Clinic for two years and collaborated as part of the research team for its Patient Centered Medical Home. You can follow her on her blog and on Twitter via @SarahJorgenson.

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Comments on this post
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becks13 says
July 9, 2010 at 12:28 PM

Well, I think you raise an extremely important point here. Why do they get to flourish with these benefits? I think the question may need to be, should this be legal at all? Should advertising be allowed to Doctors? For instance, what if I am sick, but they are not sure what with exactly? A Doctor may be more inclined to try certain drugs that he has endorsed, waste my time, and eventually my sickness (cancer, heart disease, whatever,) gets far worse. How do we begin to seperate whether that Doctor was legitimate in producing such drugs for me, or if he/she was just trying to make some extra cash. I think this severely limits our trust and respect for our Doctors and you do a good job of pointing that out. Good article.

Kafi Grigsby says
July 9, 2010 at 3:08 PM

I'm with you, Sarah. I think that the Sunshine Act is indeed a step in the right direction, but don't have much faith that many of us will go on line to investigate our doctors' conflicts of interest. That said, I have great faith in doctors, and don't think that they will prescribe drugs that are not effective. Doctors want their patients to get well and so while I can see doctors prescribing new drugs to patients because they've been introducted to them by their very friendly pharmaceutical rep, I don't see them continuing to write prescriptions for drugs that bring their patients back complaining. I'm just not so cynical...