A Spoonful of Cash

Finally stepping up to the plate on promises of curbing cronyism and undue influence of corporate cash, the Obama Administration has acted to interdict the often-too-cozy relationships forged by lobbyists and decisionmakers. Only in medicine rather than in politics.

The Obama Administration has moved to introduce new disclosure requirements requiring doctors and medical device/pharmaceutical companies to disclose any money or other compensation (e.g., free lunches, paid trips to professional conventions, etc.) paid by the companies to doctors. This would give consumers access to a database that shows whether their doctor is getting paid by the drug company he or she’s now telling you you need. Which might mean that doctors’ dignities may start getting in the way of accepting “perks” too freely.

Poor doctors. It’s almost a definitional oxymoron. But that’s the gist of what Christopher White, executive vice president of the Advanced Medical Technology Association, wants you to think.

Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation.

Their argument appears to claim that doctors are worried that their patients might look down on professional, clinical work in drug discovery and development…or something? Stripped of bullshit, it really means that drug companies won’t be able to sit doctors down, and give them a physician’s version of a hard sell so that the doctor can tell you to get some. The notion that any kind of wheel-greasing would be necessary is absurd when you remember that your doctor would seek out whatever medicine is proven most effective on its own merits regardless of whether or not he or she was given a free trip to the Bahamas to learn more about it.

ProPublica, an awesome, independently-funded investigative journalism group, has already made the empirical case in favor of disclosure in their coverage in Dollars for Doctors. They’ve found actual, causal relationships between the amount of lobbying money spent by device manufacturers or pharmaceutical companies and the choices of which procedures doctors use or the prescriptions they prescribe. And these findings were only based on limited data that had been made available through small, private databases that had been created in the wake of class-action settlements. Yet they still found pretty concrete evidence that there is a definite relationship between the drugs doctors prescribe and spending by those drugs companies.

In the economic sphere, however, this may even reduce overall spending on health care since medical practice is basically oriented around doing every possible thing to prolong life no matter the cost or quality of that life. In a weird way, if our biggest goal were to control health care costs, we’d be rooting for doctors to have fewer tools in the tool-belt, just to blunt their effectiveness a little bit away from the absolute cutting edge. Of course, the converse of that argument is that it is “good for the economy” since the pharmaceutical companies are raking in tons of money as a result of the prescriptions on the cutting edge (the ones without generic competitors yet). But “good for the economy” may still mean a tax that is imposed on the consumer in the form of decreased overall welfare through monopolistic extraction by the device/drug companies.

And so the old saying goes, “sunlight is the best disinfectant.” Let’s just see if it’s also a decent antibiotic.