Prescribing data and the side effects of assumptions #ahcj14

Reporters curious about the financial relationship between physicians and pharmaceutical companies can use publicly available data as a starting point – although that comes with some caveats, journalists and industry leaders say.

During the workshop “Covering prescription drug data,” Charles Ornstein, ProPublica senior reporter, pointed out resources that ProPublica has created that reporters can use to write stories about doctors in their communities.

Dollars for Docs

  • Dollars for Docs allows you to search what physicians in your area, if any, have received payments from pharmaceutical companies for speaking, consulting, meals, etc.

  • Information in Dollars for Docs is based on disclosures from pharmaceutical companies that have disclosed information regarding payments to physicians for speaking, consulting, meals, etc.

  • The data only includes payments from 15 companies. (Ornstein noted that almost all companies, mostly through lawsuits with government, agreed to make their payments payments)

Prescriber Checkup

  • Based on Medicare Part D data, this resource allows you to search by doctor, ZIP code or state to learn how doctors in your area prescribe certain drugs.

  • Through the Prescriber Checkup’s dashboard, you can see how a doctor stacks up against peers in his or her region.

  • For example, you can see how a provider’s narcotics prescribing habits stack up against his or her peers in that region.

  • “This is real money, these are real patients, and this is a real doctor who’s making these decisions,” Ornstein said, regarding a doctor who stood out among others in his prescription habits.

And more data is coming, with the release of data under the Physician Payments Sunshine Act.

During the workshop, Kendra Martello, deputy vice president of strategic operations at Pharmaceutical Research and Manufacturers of America, shared the industry perspective on journalists covering prescription drug data.

Martello said patients deserve to have all of the information that they need to make informed health care decisions. She repeatedly mentioned that journalists should consider the “big picture” and not jump to conclusions about what data about pharmaceutical company payments to physicians means.

“Numbers without context, from my perspective, don’t add up to anything meaningful,” she said. “So when we’re covering these stories, keeping the big picture in mind and understanding how the big picture fits together is important so we can present a balanced view.”

Martello repeatedly referred to the PhRMA Code on Interactions with Health care Professionals, which she said serves as a guideline for how the industry can ethically interact with health care professionals.

Among the points she addressed regarding payments to physicians, Martello touched on pharmaceutical company speaker bureaus – when companies pay doctors to speak to a group of doctors about a drug.

Martello said these programs are not unlike a “train the trainer” program.

“From my perspective, this is physician educating other physicians about the safe and appropriate uses of medicines,” she said. “And, from our perspective, an educated physician provides better patient care, and, again it’s actually not just me saying it. Even in a recent letter to Marilyn Tavenner from about 20 members of Congress, they acknowledged that physician education is important to advancing and benefiting patient care.”

The next panelist, Eric Campbell, professor of medicine-health policy at Harvard Medical School, was a counterpoint to much of what Martello said.

Campbell presented survey data, which was published in the New England Journal of Medicine and the Journal of the American Medical Association, about how frequent the relationships are between doctors and drug companies.

“The point I want to make is, there is not a single area of medical education, medical research or the practice of medicine in which financial relationships between drug companies and doctors are not almost ubiquitous,” Campbell said.  “In fact, in most areas of research, it’s hard to find doctors who actually don’t have financial relationships with industry.”

Through his research in a number of survey studies, he saw:

  • 53 percent of medical school faculty report that they got something from a drug company in the last year. The average value of that was about $5,000, not including their research money which goes to their institution.

  • One-third of institutional review board members – “people who oversee research in medical institutions,” Campbell noted – have drug company industry relationships

  • 60 percent of medical school department chairs had industry ties as well

Campbell said that, in their most recent survey, they found 84 percent of practicing physicians had some kind of financial relationship with drug companies.

Relationships between drug companies and physicians are frequent and can take on a variety of forms. Meanwhile, patients largely disapprove of these types of relationships, he said.

Campbell pointed to a Consumer Reports National Research Center survey that found 74 percent of respondents disapproved of doctors taking payments from drug companies in exchange for promoting specific drugs to other doctors, and 77 percent would be concerned about the quality of treatment or advice from a doctor who accepts such payments.

“If we want to talk about the patient perspectives, let’s talk about the patient perspective, not in anecdotes, not in ‘I thinks,’ but in real data – that’s the real data,” he said.

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