Drugmakers vow to disclose their payments to physicians

Three of the country's top-10-selling drugmakers have pledged to publicly disclose their financial relationships with physicians. The move comes ahead of bipartisan congressional legislation, the Physician Payments Sunshine Act, that would mandate such reporting. The bill is widely expected to pass in some form next year.

Eli Lilly and Co. in September said by the second half of 2009 it would report payments to its physician speakers and advisers. By 2011, the Indianapolis-based drugmaker would publicly report all physician compensation that exceeds $500 a year, including food, entertainment, gifts, travel and continuing medical education, as specified in the Sunshine Act.

"Physicians perform some extremely valuable services for not only Lilly but for the entire pharmaceutical industry, and you hate to have that relationship diminished by questions of possible distrust about that relationship," said Eli Lilly spokesman Ed Sagebiel.

Lilly's public reporting initiative will "hopefully eliminate some of those questions and show the public why we are paying physicians and what it is we're paying them to do," he said.

Some physicians already have complained privately about the plan, Sagebiel said, but Lilly does not expect the disclosures to hurt its relationships with doctors. No physicians have said they plan to stop speaking or consulting for the drugmaker because of the pending Internet payment registry.

Merck & Co., a day after the Lilly announcement, said beginning next year it too would report payments made to doctors serving the Whitehouse Station, N.J.-based company as promotional speakers.

In October, GlaxoSmithKline announced its intent to publicly disclose payments to U.S. doctors while capping annual compensation at $150,000. Details on whether the public reporting would apply to all physicians, or only to those who serve as speakers or advisers to GSK, were not available at press time.

Analysts say they saw this coming

Pharmaceutical industry analysts said it should come as no surprise that some drugmakers are taking the initiative in making payments to doctors public.

"The industry, for a numbers of years, has been maligned -- whether right or wrong -- because of its relationships with physicians and specialists," said Hussain Mooraj, vice president of health care and life sciences for the Boston consulting firm AMR Research. "[The industry] never really did anything to counter those allegations, which only fueled the fire of mistrust between the patients and the pharmaceutical companies. And this new transparency is going to throw a bucket of water on that fire."

Mooraj said the firms' physician payment registry plans are "certainly going to put a lot of pressure on other companies" to follow suit.

Eli Lilly, Merck and GSK support the Sunshine Act and said the voluntary initiatives are not intended to stifle the legislation. The Pharmaceutical Research and Manufacturers of America supports a revised version of the legislation that preempts state gift-disclosure laws and would only require reporting of aggregate annual payments exceeding $500. The American Medical Association also supports the revised bill.

Daniel J. Carlat, MD, a former drug firm-paid speaker now critical of the pharmaceutical industry's physician marketing tactics, lauded the drugmakers' payment registry plans for "enhancing transparency and honesty in medicine."

He predicted that "over the next five years, we will see a lot more initiatives from different companies, whether it's disclosure of payments or reforms in the ways companies are willing to pay for CME or guidelines for physician behavior when doing marketing for drug companies.

"This is really just the beginning," said Dr. Carlat, assistant clinical professor of psychiatry at the Tufts University School of Medicine in Boston.

Yet Dr. Carlat said he doubts that "patients are going to be running to these databases to see how much their doctors are getting from drug companies."

He said the impact of physician payment registries is that "people who regulate physician behavior will have that data to connect the dots."

That is precisely what worries Thomas P. Stossel, MD, who directs the division of translational medicine at Brigham and Women's Hospital in Massachusetts.

Patients do not really care about doctors' financial relationships with drugmakers, he argued, and the disclosed payments will provide fuel for "the critics, the embarassers, the media and the tort lawyers."

But Dr. Stossel, a hematologist who has done research on cell motility and consulted widely for drugmakers, said "the doctors who are honest, hardworking, taking good care of their patients and innovating should be prepared to look on this database as a badge of honor. They're paying for me because I'm good and providing a service."