551- 9

Lesson nine

Who is guarding the

Hen house?

1. READ Medtronic paid millions.

http://www.jsonline.com/watchdog/watchdogreports/medtronic-paid-millions-to-influential-uw-chairman-ca3c6nn-136240963.html

2. orthopaedic devices

Some physicians have made improvements to medical devices and are legitimately eligible for royalties for their work, others have collected fees for legitimate research. Unfortunately others have received payments which appear dubious at best. In 2007 the four major manufacturers of orthopedic devices entered into an agreement with the federal government agreeing to pay the government a total of $313 million. They also agreed that they would for a period of 18 months publicly disclose who they were paying money to. When the numbers came out there was a suspicion in some circles that money was being thrown on big users of the devices and on teaching faculty who had the ability to “start new surgeons out on the right track”.

READ

http://earlsview.com/2011/08/20/u-s-government-examining-doctor-kickbacks-for-medical-devices/

ALSO READ The rich and famous

https://www.forbes.com/sites/matthewherper/2012/07/02/feds-say-dr-drew-was-paid-by-glaxo-to-talk-up-antidepressant/#66fcbcf251ec This describes the way in which one drug company used a celebrity physician to tout their product in settings where people didn’t know or realize they were in essence listening to a paid commercial. Is what is okay for physicians to behave like the Kardashians and other internet influencers?

3. .In 2014 the Physicians’ Payment Sunshine Act went into effect, it requires drug and device makers to publicly disclose payments to physicians.

The Sunshine Payments Law requires pharmaceutical companies and device manufacturers to disclose to the federal government the payments that they make to physicians. The law was very controversial when passed. Doctors feared that the data contained in the annual disclosure forms would be misunderstood by the general public. What has instead happened is that every year the government publishes the data and every year no one pays attention to the data. The government recently released the data for the year 2019*.

The data shows that 615,000 doctors received payments from drug companies

and device manufacturers. The Henry J. Kaiser Foundation reports that there are 1,005,295 active physicians in the United States. The amount paid to doctors as what are designated as “general payments” was $2.14 billion. This number has remained relatively stable for several years. “General payments” do not include money paid for research, but do include royalties paid to doctor-inventors, and includes the cost of lunches, speaking fees, and other money or value provided to doctors.

Big drug companies spend big money promoting their products and cementing their relationships with doctors. As an example, for the year 2018 pharmaceutical giant Astra Zeneca listed over 450,000 reportable transactions with physicians. The money or value delivered to doctors in those transactions was over $45,000,000. These were “general payments”, (things like lunches). In addition to the general payments Astra Zeneca paid doctors over $220,000,000 for research.

Obviously, some physicians did better than others. As an example, the average amount paid to an orthopaedic physician in 2015 was $26,080. This does not mean that all orthopaedic physicians received money. Some of this was paid to physicians who invented a particular device and received royalties and some of it represented lunches and free medical education given to doctors.

*the data base it can be found at https://openpaymentsdata.cms.gov/summary recent improvements have made it far easier to use.

5.This article from USA Today looks at physicians practicing in Tennessee hospitals.

https://www.usatoday.com/story/news/2016/06/29/tennessee-hospital-leads-us-doctors-taking-drug-industry-money/86506888/

6.In 2018 the American Medical Association’s House of Delegates voted in favor of a motion to urge the government to amend the Sunshine payments law by altering the threshold so as to exclude payments of less than $100, (the threshold is currently $10), and to allow drug companies to provide doctors with textbooks and reprints from journal articles without reporting those transactions. https://www.policymed.com/2014/06/physician-payment-sunshine-act-ama-house-of-delegates-votes-to-increase-minimum-reporting-requirements-to-100-payments-and.html

Assignment for lesson nine

1 Critics of the Physicians’ Payments Sunshine Act exist on both sides. Would you favor leaving the law as is, repealing the law, or amending the law. Give reasons for the approach you favor.