A federal website that lets patients look up doctor's payments from drug and medical device makers is expected to go live on Tuesday, a database that will add new depth and details about the medical world's financial ties to the industry.
The website, which was required by the recent federal health care law, is being hailed by consumer advocates who point to studies that have shown that doctors' financial relationships to drug companies affect their prescribing practices. Although some of this information has been available elsewhere, the data includes payments from virtually every pharmaceutical and medical device maker, regardless of size, as well as information about doctors' ownership interests in companies.
But the database is being questioned by the drug and device industry, as well as doctors, who say that technical problems and data inaccuracies limit its value. In September, the major industry groups expressed concerns that the data would not provide consumers with the proper context for understanding the payments and said they had not been properly consulted on how the data would be described.
Under the new requirements, all manufacturers of drugs, medical devices and medical supplies that have at least one product covered by Medicare or Medicaid must report payments or gifts they make to doctors and teaching hospitals. This can be as seemingly trivial as a bag of bagels - all payments more than $10 are included - or as lofty as a research grant. It also includes meals, travel expenses and speakers' fees. Group-purchasing organizations, which serve as middlemen between health care providers and manufacturers, also must disclose doctors' ownership and investment interests in their companies.
Critics of the drug and device industries said the website would shed new light on practices that are often of questionable value to patients. Several studies and reports, including one by the New York Times, have shown that doctors with relationships to industry are more likely to prescribe more expensive and potentially inappropriate drugs than those who do not.
'When you look at why do drug companies and device companies make gifts and offer consulting payments and honoraria to physicians, the main goal is to influence prescribing practices,' said Dr. Michael Carome, the director of Public Citizen's Health Research Group. 'The interest of those companies is to improve their financial bottom line, and not necessarily represent the best interest of patients.'
But doctors and industry representatives said such criticism obscures valuable relationships and is precisely why they worry that the new data could be misconstrued. Drug and device makers say they regularly consult with doctors to help them decide where the need for innovation is the greatest, and doctors conduct clinical trials that help get the products approved.
'We have very close relationships with physicians who use our devices in the field, and those physicians bring back valuable ideas, and help us develop new improvements,' said Christopher L. White, general counsel of AdvaMed, an industry trade group for device makers.
Several major drugmakers have been reporting payments to doctors for years as a result of legal settlements over their marketing practices, which is available on a website run by ProPublica, the nonprofit news organization. But some major drug companies, such as Bristol-Myers Squibb, Roche and Sanofi, are not included, as are some makers of major blockbusters like Solvadi, the expensive new hepatitis C drug made by Gilead.
Medical device companies were also not listed on that website, although some companies make such disclosures on their own. Some states, including Minnesota, Vermont and Massachusetts, had passed similar requirements in recent years.
Now, every major drug and device maker will be required to report such payments, and they will be available on one central government website. 'It's a scope and scale issue,' said Dr. Robert M. Wah, president of the American Medical Association.
He and others questioned the value of Tuesday's data release because it carries significant caveats. For one, the database currently covers only payments made between August and December 2013.. This summer, the Centers for Medicare and Medicaid Services, which is overseeing the release, announced that it was sending up to one third of the records back to manufacturers for review, following reports that at least one doctor's records were commingled with those of another with the same name.
Dr. Wah said his members have reported a range of problems with the website to which they were granted advance access to the data to verify its accuracy. Some had trouble logging on. Others found the information to be wrong.
That was the experience of Dr. Raed Dweik, a Cleveland Clinic lung specialist who said he was surprised to see that the drugmaker Boehringer Ingelheim had reported that he had received a lunch worth about $50 during a presentation at the clinic. Dr. Dweik, who is chairman of the clinic's conflict of interest committee, said he had spoken at the event but deliberately skipped the lunch, as he always does. He said he believes the company simply divided the number of event participants by the cost of the meal and did not check who attended the lunch.
'I'm very sensitive about this,' Dr. Dweik said, adding that other drug companies have also previously marked him down for lunches he did not eat. 'I make it clear ahead of time that I'm not doing it.'
Dr. Dweik said he disputed the payment with the federal government and does not know how it will show up when the website opens. His personal experience, he said, led him to warn other physicians at the Cleveland Clinic to closely scrutinize their records.
'I think the concept itself is really good,' he said.
However, 'the problem with this website is one has no context,' he added, 'You don't know if this relationship is legitimate or not, and the bigger problem is the inaccuracies.'
Even as the public will gain greater access to information about payments to doctors, the industry has for years been moving away from such interactions, both in anticipation of the new disclosure and because of other market forces.
For many years, the speaker event was a classic drug-industry marketing tactic. A company would hire a respected doctor to speak about their product to a room of his or her peers, often over dinner. The speaker would receive a fee, as would the doctors who attended.
Pratap Khedkar, who oversees the pharmaceutical practice for the marketing firm ZS Associates, said some companies and doctors are rethinking these events. Many doctors simply don't have the time, and with public reporting of the payments they receive, they may think twice about participating. Some companies have shifted to online events, via webinars, where the only paid doctor is the speaker, and have cut their budgets for such in-person events by 30 percent to 50 percent.
'Doctors say, you know what, I love to speak or I love to attend these things, but I don't want to be flagged as an outlier,' he said.
Some said the disappearance of these types of events isn't such a bad thing. It may lead the medical community to shift away from educational programs sponsored by pharmaceutical companies, said Dr. Aaron S. Kesselheim, an associate professor of medicine at Harvard Medical School and Brigham and Women's Hospital.
'These kinds of events, while they can have value, have been abused in the past and that's one of the reasons why we're in the situation that we're in today,' he said.
