Editorial: Towards greater transparency

Published in The Hindu on November 5, 2007

Pharmaceutical companies and doctors make for uneasy bedfellows.  While the two cannot ignore each other, there is the growing expectation that doctors would keep drug companies at arm’s length. There is much evidence to show that pharmaceutical companies have uncanny ways of influencing doctors’ prescribing decisions.  Expensive gifts, sponsored conferences, lavish holidays, compromised medical education in the garb of continuing medical education have all become common.  The malaise has plagued the health care system to such an extent that prescribing practices such as unnecessary medication, prescribing expensive medicines when cheaper equivalents are available, off-label use of medications and “premature adoption of novel treatments” do not keep the best interests of patients in mind.  The British Medical Journal in 2003 reported that drug companies did “admit to rewarding doctors for switching from one drug to another but maintained that this was “standard industry practice.””  While doctors maintain, and at times vehemently assert, that their prescribing trends are less influenced by the industry, it is common knowledge that companies would not “spend $19 billion each year establishing and maintaining [the relationship]” unless it translated into increased sales.

A disclosure bill introduced recently in the U.S. Senate aims to bring about more transparency.  The Physicians Payments Sunshine Act requires manufacturers of drugs and medical devices with an annual turnover of $100 million to disclose the payments made to doctors.  While this is the first time that efforts are being made at the national level, five States and the District of Columbia already have such disclosure laws in place. Minnesota, the first State to introduce the requirement in 1993, and Vermont, ten years later, have made it mandatory to make payment disclosures publicly available.  Several institutions have taken steps to sever the nexus between drug companies and doctors.  Though such local initiatives have been largely successful, that a legislation with sufficient teeth to punish the erring parties is required becomes clear as an investigation found that payments made to doctors by companies in Minnesota and Vermont were either hard to access or did not reveal the recipients’ identity.   To be truly successful, the legislation should make doctors equally accountable. While it would be ambitious to expect the legislation to completely cleanse the system, it can be hoped that drug companies that have a problematical relationship with every arm, starting with the regulatory authority down to the patient groups, will be forced to be more careful in their promotional activities.