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Transparency: getting the cost-benefit balance right

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By AMA Secretary General Anne Trimmer

The AMA has responded to the transparency proposals under consideration as part of the review by Medicines Australia of its Code of Conduct.

The AMA submission attracted predictable headlines that doctors don’t want light to be shone on their relationships with pharmaceutical companies.

A closer reading of the AMA’s submission shows a very different position.

The AMA supports increased reporting measures where that reporting can inform a patient’s understanding of the relationships that his or her doctor has with pharmaceutical companies.

What the AMA does not support is a detailed reporting of ‘tea and biscuits’ or ‘coffee and muffins’ benefits, which would add considerable cost to the health system with no improved understanding of the relationships that might influence a doctor’s prescribing or recommending practices.

In its submission, the AMA specified that a successful reporting model would:

  • provide information to enable patients to make well-informed decisions about their health care options, taking into account the context and nature of their doctor’s involvement with a company;
  • not deter or constrain legitimate and ethical relationships as governed by industry and professional codes of conduct; and
  • provide value to patients while balancing the red tape and resources impact  on both companies and doctors.

It is useful to understand the origins of the US Physicians Payment Sunshine Act on which many proponents would like to base the Medicines Australia reporting requirements.

While now part of the Patient Protection and Affordable Care Act, it was originally proposed by Senator Chuck Grassley (Republican, Iowa) and Senator Herb Kohl (Democrat, Wisconsin).  The Senators pushed for a disclosure regime to address two ills they perceived in the US health care system:

  • inappropriate prescribing or product use where the prescribing or use was influenced by the relationship between a health care practitioner and a pharmaceutical or medical device company; and
  • unnecessary costs in the healthcare system attributable to expenditure on non-essential engagement between companies and health care practitioners.

When looked at in context, the types of arrangements that might be considered to influence a doctor’s actions are those where the doctor derives personal benefit, for example in the form of consulting fees, advisory board fees, royalties from co-development of a product, or sponsorship to attend an educational event. 

These are the types of benefits that the AMA proposes should be disclosed so that patients can be fully informed of any relevant relationship.

However, to extend the reporting requirement to benefits such as coffee and muffins distracts from these more significant relationships, and adds considerable cost to the reporting system. That additional cost has to be measured against the perceived ‘ill’ that such disclosure is thought to address.

Ultimately, any additional cost incurred in reporting to minute levels of detail (and there are considerable costs in developing and incorporating these systems both for companies and doctors) results in additional costs in the health care system. And for no perceivable benefit to the patient.