How useful would a database cataloguing the money that doctors receive from medical drug and device makers—for speaking, research, meals, travel, etc.—be to journalists trying to ferret out potential conflicts of interest?
Just ask ProPublica, which launched its Dollars for Docs database in October 2010. It was the first, freely available resource of its kind, based on data that a dozen drug companies began posting on their websites in 2009 as a result of legal settlements with the federal government.
With it, the investigative news outlet “uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.” A couple of months later, it revealed that several medical schools had failed to enforce policies barring their doctors from giving paid promotional talks for pharmaceutical companies. The site’s reporting prompted Stanford University to take disciplinary action against five faculty members. And it’s not only ProPublica that has made use of the database.
Following the launch, reporters Charles Ornstein and Tracy Weber, who helped construct Dollar for Docs, held a conference call for reporters and editors from dozens of news organizations to talk about how to best use the database to find stories their readers would care about. The effort paid off. Papers such as The Boston Globe, St. Louis Post-Dispatch, The Denver Post, Orlando Sentinel, and The Plain Dealer in Cleveland have used ProPublica’s data to “localize stories about conflicts of interest in medicine—bringing the discussion to communities large and small.”
“It’s clear that journalists and the public are hungry for this information,” Ornstein wrote in an e-mail to CJR. “Because the companies that have released data only account for about 40 percent of US prescription drug sales, and a far smaller percentage of firms, there’s much data that have not been released.”
Thankfully, the data is on the way. The New York Times reminded readers in a front-page story on Tuesday that provisions in the 2010 health-care reform law mandated that all drug or device makers with at least one product covered by Medicare or Medicaid must begin disclosing the money they give to physicians (other than its own employees) for a wide variety of reasons. While such remuneration is not illegal, and while advocates say it fosters better service and innovation, it also clearly affects the way physicians treat their patients.
“Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves,” the paper’s Robert Pear reported. “The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.”
Under the new standards, which are supposed to go into effect this year, companies must report their payments to doctors to the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), which will then post the data on a publically available website. Unfortunately, it will be a while until that useful bookmark is available to reporters.
In the Times, Pear pointed out that the new disclosure requirements are already overdue. CMS was “supposed to establish payment-reporting procedures by Oct. 1, 2011,” but it didn’t get the proposed regulations into the Federal Register until mid December. Because of the late entry, companies didn’t have to begin collecting payment data on January 1 as they were originally supposed to. Nonetheless, CMS hopes to finalize to the rule in time for companies to begin reporting payments by the March 31, 2013, as originally required. If all goes well—and there’s no guarantee that it will—CMS will start posting the data online by September 30, 2013.
It's very hard for me to criticize this otherwise fine article because it will smack of self-conceit. But I feel compelled to say that my role in Dollars for Docs should have been mentioned.
Not my name, necessarily, but more of the details. Because it was never as simple as just scraping together and compiling various documents and websites to make a database. To me, that wasn't even the most compelling part of the project. With the payments data in hand, Charlie and Tracy had the brilliant idea to cross-reference it with the various state medical board and medical school sites to find matches.
The important context behind all this is that we don't have the prescription data that would allow us to determine if compensation has any correlation/causation to prescribing practices. So the best we could do was use another public source of data to point out that the companies' claims that their financial relationships are reserved only for the most upstanding of doctors doesn't stand up to muster.
This is an angle that will not be automatically available or evident if and when the government publishes its official database. Because of the need to balance granularity of data with making a user-friendly interface, whatever the government creates will obscure some part of the larger picture. Even when given big data, journalists must continue to be vigilant and resourceful in analyzing it and systematically connecting the dots with out disparate data sources.
#1 Posted by Dan Nguyen, CJR on Fri 20 Jan 2012 at 01:12 PM
Thanks for the thoughtful comment about the complexity involved in making good use of Dollar for Docs, Dan. I've amended the column to mention your role in creating the database; apologies for the oversight.
#2 Posted by Curtis Brainard, CJR on Fri 20 Jan 2012 at 01:27 PM
Do you know if this disclosure rule will also include physicians who act as advisers in formulating treatment guidelines?
#3 Posted by Kat, CJR on Mon 23 Jan 2012 at 12:56 PM
Mr. Brainard,
You, or maybe the brave NY Times journalists, should have really investigated a little more. My father, now deceased, was a physician, and was regularly visited by 'detail men' -- drug company reps -- who would give him samples of their latest products and information on new products, along with promotional nick-nacks -- opens, note pads, etc.
My father always enjoyed their visits as a half-hour break from patients, and opportunity to get boxes of free sample sized products (which he could then pass on to his mostly poor patients).
Nowadays, drug reps aren't called detail men, but they commonly come and make appointments with the secretaries to take the doctor to lunch (the doctor has to eat sometime, after all) at which the same old functions are performed -- doctor gets new info, free samples to give away to patients, and promotional nick-nacks.
None of this is nefarious at all. Does it influence the doctors choice of drugs? Probably, that's what advertising is designed to do, influence us (the consumers) to use one laundry soap over another -- neither of which is superior to the other, in most cases.
Does it cause doctors to use dangerous, untested drugs in untested ways? For the vast majority of doctors, I very much doubt it. And I don't think there is real evidence to the contrary. Certainly none is presented here.
#4 Posted by Kip Hansen, CJR on Sun 29 Jan 2012 at 06:25 PM