Sunshine Act: Are Doctors Still Enjoying Free Lunches From Drug Reps?

Leigh Page


November 21, 2017

In This Article

Changing Physician Behavior Through Transparency

The PhRMA code, adopted in 2009, still allows reps to provide "occasional" meals in doctors' offices "in conjunction with informational presentations," though it rules out restaurant meals. Of course, individual companies are free to ignore the PhRMA code.

Likewise, individual doctors are free to make up their own minds. Many employed physicians at large organizations, however, are an exception. Increasingly, they have to operate under institutional rules about conflicts of interest. For example, many academic medical centers now ban meals and small gifts, though most of them still allow drug reps in, according to a May 2017 study in JAMA.[16]

Researchers found that these new rules actually saved the academic medical centers money because their physicians were more likely to order generic drugs than more expensive brand-name drugs. "The study indicates that physician practices and other governing bodies may need to take an active role in regulating conflicts of interest, rather than relying on individual physicians to monitor and regulate," according to a press release[17] about the study.

But with the exception of large organizations, the conflict of interest movement does not force any standards onto physicians. That makes it different from some other government programs, such as CMS's new Merit-Based Incentive Payment System.

Open Payments Site Falls Short

Rather than creating rules, the conflict of interest movement tries to change physician behavior through transparency—an approach that has become the Holy Grail among many healthcare leaders. In a 2007 Commonwealth Fund survey,[18] three quarters of healthcare opinion leaders supported transparency in healthcare.

Ideally, transparency is about accurately reporting what physicians are earning and forcing them to defend these payments to a very engaged community of colleagues, patients, and the public. But the Open Payments site falls short of the ideal.

The Open Payments website got off to a rocky start when it opened in late 2014. Data were based on only the past 5 months of activity in 2013. Owing to mistakes in the reporting process, 190,000 submitted records were withheld and 40% of the remaining information was "deidentified"—that is, not attributed to any particular provider.

Reporting data on physicians has been very expensive for drug and device companies to carry out. "It probably cost industry over a billion dollars to set up their reporting systems and then about half a billion a year to operate them," Sullivan says. "This is money that could have been used for research."

"The small companies really struggled to bring the data together," he says. "Large companies have whole staffs to take care of this, but anyone who deals with this amount of information at such a granular level is going to make mistakes."

In fact, a lot of mistakes. Sullivan cited the MedPanel survey[4] of physicians who had checked their information on the Open Payments website. About one half of them found inaccuracies. Whereas 30% said they had been attributed payments they were not aware of, 14% said payments that they know they received were not reported.


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