Sed quis custodiet ipsos custodes?
But who will watch the watchmen?
The NY Times has an article today about Sen. Charles E. Grassley (R, Iowa) and his proposal to require “drug makers to disclose the payments they make to doctors for services like consulting, lectures and attendance at seminars.” Any doctor who collects payments for Medicaid/Medicare – aka almost all doctors – would be subject to this requirement, and the information would go into a national database.
I have several problems with this proposal, but let me start with what I think is right. I think doctors should disclose the payments they receive from drug companies. I think it’s in the best interest of patients, the consumers, to have this form of transparency in the system. It’s good to know whether your physician is prescribing a particular medicine because he thinks it’s the best, and not because the company who makes the drug paid him a hefty sum last year to speak at their conferences. Of course I also understand that just because the doctor received payments from a drug company doesn’t mean that that drug is bad (it may in fact be the best drug available).
Here is where I have a problem:
1) There is a big difference between “should” and “must.” Doctors should disclose their pharmaceutical ties, but I don’t think they should be forced to. This is a moot point in our current health care system, because patients don’t get the opportunity to really shop around, so to speak, for their care. In an ideal system the patient would have an incentive to choose a physician that meets criteria they consider most important – for one patient it may be the stellar reputation of the doctor, for another it might be the proximity of the clinic, etc. In this system there would likely be consumers that reward physicians (by choosing them to provide services) who disclose their dug company ties. I think some patients want this info, but there would probably be some who could care less.
2) A national database, run by the government, is just screaming potential for misuse. It may start as a mere collection of drug company payments, but what other information would they collect (NSA phone database)? If they don’t like what they see, what types of legislation will they write to regulate pharmaceutical companies, doctors, or health care in general? How safe will that info be? The government, after all, has a bad track record when it comes to protecting the databases they currently run (Veterans Affairs ring a bell?).
Given the government’s poor track record, and the knowledge that there are other ways to get doctors to disclose pharma ties that don’t involve force or coercion, I think this legislation is a terrible idea.
Somewhat related – for a good article about the problems with a national medical-records database, click here.