Disclosure? Not Good Enough.
In compliance with a federal integrity agreement, pharmaceutical giant Pfizer released details of its financial involvement with the medical community.
According to the New York Times, the drug maker disclosed that it paid $20 million in consulting and speaking fees to 4,500 doctors in the second half of 2009. The company also shelled out $15.3 million to U.S. academic medical centers for their clinical trials.
A few other drug makers have disclosed their payments to physicians in the past, but this is the first time a company has disclosed its payments for clinical trials. As such, some may see this as a good deed on Pfizer’s part, a noble step towards eliminating or reducing some of the conflicts of interest in medicine.
Only, disclosure doesn’t seem to help. Several studies have shown that when professionals disclose their conflicts of interest, this only makes the problem worse. This is because two things happen after disclosure: first, those hearing the disclosure don’t entirely know what to make of it — we’re not good at weighing the various factors that influence complex situations — and second, the discloser feels morally liberated and free to act even more in his self-interest.
So, in this case the people who run Pfizer will likely feel even more entitled to disregard the public good, and the public, in turn, will not know what to make of the numbers it released. After all, what do you make of the numbers? It’s hard to figure out from a statement of disclosure just how much influence the conflict of interest had on the discloser, and to what degree we should be wary of them as a result.
The real issue here is that people don’t understand how profound the problem of conflicts of interest really is, and how easy it is to buy people. Doctors on Pfizer’s payroll may think they’re not being influenced by the drug maker — “I can still be objective!” they’ll say — but in reality, it’s very hard for us not to be swayed by money. Even minor amounts of it. Or gifts. Studies have found that doctors who receive free lunches or samples from pharmaceutical reps end up prescribing more of the company’s drugs afterwards.
It’s just a fact of human life: we are compelled to reciprocate favors, and an ingrained inability to disregard what’s in our financial interest. As author Upton Sinclair said, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”
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In addition to your two reasons already cited I think another aspect of disclosure that might make it worse is social proof – the “keeping up with the Jones mentality.” A good example is the S&P 500 CEO pay data you shared in Predictably Irrational. In 1976 CEOs made 36x more than the average worker. By 1993 it was up to 131x more, the year the Fed mandated full disclosure of CEP compensation. Part of the reasoning of the Fed was CEOs and shareholders would be shamed in to paying less because of public pressure. Unfortunately it backfired as CEO pay rose to 525x more than the average worker by 2000! Once companies saw what other companies were paying and once CEOs saw what others were earning it was a bidding war similar to athlete’s pay. In fairness to CEOs, by 2009 their pay had dropped to a paltry 263x the average worker but that probably has more to do with overall economic woes and lower bonuses than compensation coming under control.
Good stuff as always Dan. Brian
Just being able to comment on the typo in the last sentence of the fifth paragraph (“…the degree to which we should be weary/wary”) makes me want to forget all about it.
So, the consulting-and-speaking fees average out to $4400/ MD. Given the delta between median and average, it’s more likely that twenty MDs got a whole pile o’cash, and the rest had their carfare paid. It would be more useful to see the breakout.
I’m surprised that anyone could run a clinical trial of any size, let alone more than one of them, for $15M. Quintiles, just one of the players in the field, reports annual sales of $3B.
Are you suggesting that perhaps our tax dollars should be paying for the time and effort expended on running clinical trials at public universities and hospitals? Can’t see how that works out more honestly.
I have a hard time thinking that less sunlight is the answer. If disclosure doesn’t work because the general populace doesn’t know what to do with it and the people involved feel less shame when they know others are doing the same thing, that suggests that the answer is in bridging that gap. Help the general populace increase the shame of the beneficiaries.
Perhaps using your recent “10 commandments” tests as an example, every prescription pad should have printed on it something like “remember that your obligation as a prescriber is to the patient, not the drug company”.
Perhaps on the patient end, in addition to the ticky box that is now on most paper and electronic prescriptions about whether a generic is available, there could be a ticky box where doctors disclose to the patient whether or not they have received fees or gifts from the drug company they’ve just prescribed. Pharmacists can ask in plain English as part of their usual patter with the patient if they understand it.
that Could be an excellent idea, the public is Exposed to the Information in the wrong circle, too far to be effective.
Considering all the efforts made by brands trying to turn “transparent”, it’s a little freaky
Dan, I get the point, but I still think that this kind of disclosure could be positive, since it calls some attention to the topic (yours, for example) and can possibly lead to some better regulation, or, even better, but maybe too optimistic, to a day that one company identifies an oportunity to disclose that “we don’t do this kind of thing” (here I’m thinking about the cosmetic companies that don’t test their products on animals). We still don’t know exacly how to react, having or not having the information, so I prefer to have it and, at least, I can start thinking about the real thing, instead of just being suspicious.
And the executives could feel more free to do it, but they’re going to have to explain variations in the expense, or start being subjected to questions about it, for example during results presentations, etc.
There are some good points here. However, I acknowledge the problems of disclosure highlighted in the article, but this is a step in the right direction. Perhaps the next move should be to educate “the public” on how to react or interpret such statistics. It is true many people do not realize the extent of the conflict of interest problem regarding the medical profession. At least with more openness we can address the issues or a larger percentage of them than we could have done before.interpret such statistics.
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