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The Million Dollar Bagel: Harvard Doctor Fights Back

It is dismaying that a Harvard Medical School physician would argue against a new law calling for more transparency in physicians' financial relationships with pharmaceutical companies.
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It is dismaying that a Harvard Medical School physician would argue against a new law calling for more transparency in physicians' financial relationships with pharmaceutical companies. In an article in Sunday's Wall Street Journal called "Who Paid for your Doctor's Bagel," Thomas P. Stossel, M.D. vehemently takes issue with the Physician Payments Sunshine Act, which requires that pharmaceutical companies that make drugs purchased by government programs publicly disclose any payments or perks they give to physicians with a value above $10. It also requires physicians to declare income from drug companies. This statute seeks to curb unethical conflicts of interest that arise when psychiatrists and other doctors take payoffs from drug companies to promote their products. In Stossel's view, the legislation "demeans" doctors.

In the wake of a recent scandal at Harvard Medical School, in which three psychiatrists on the faculty (Joseph Biederman, Thomas Spencer and Timothy Wilens) failed to disclose to Harvard more than $1 million in payments and other perks from pharmaceutical companies, one would think that doctors on the Harvard faculty would now welcome more rather than less transparency about pay-offs from drug companies to doctors.

In their letter of apology to Harvard University on July 1, 2011, Biederman, Spencer and Wilens wrote "We now recognize that we should have devoted more time and attention to the detailed requirements of these policies and to their underlying objectives." Yet barely seven months later, Dr. Stossel believes that physician-industry relationships have not been a problem. In the mind of a Harvard doctor, 1.6 million unreported dollars may not be substantive -- merely the price of a few bagels -- but there are many of us who think that sum constitutes real money.

Stossel also seems to disagree with his colleagues' view that in the future they should pay closer attention to policies that are intended to keep them ethical. He says: "Prior to public disclosure, physicians are supposed to review payments ascribed to them, including royalties, fees for research consulting, and reimbursements for legitimate expenses associated with these activities. And they had better check the paperwork closely, because reporting of this magnitude and granularity will contain inaccuracies." Having to pay such close attention to disclosures, Stossel believes, is tantamount to a doctor being "pilloried for eating a corporate bagel."

But of course we are not really talking about bagels here. We are talking about $220 million doled out by Big Pharma (in 2010) to doctors who gave speeches to promote their products, to doctors for conducting research that would yield only positive results for their drugs, to doctors who lent their names to articles in respected medical journals that were actually ghostwritten by marketing departments of drug companies, and to medical societies that provide continuing education for doctors.

According to the consumer agency Pro Publica, there is a large body of research that indicates that even small payments and gifts to doctors influence their perceptions of various drugs and which drugs they prescribe. There now exists a "culture of expectation" among doctors regarding perks from drug companies. They have come to rely on payments from Big Pharma to supplement their income. Drug companies can also track each and every prescription written for their products, and are they are thus able to reward doctors who do prescribe their drugs and conduct further outreach to those who do not.

Dr. Stossel holds that medical care is incomparably better today as compared to five decades ago. In many fields of medicine that is unarguably true. There is one field, however, in which Big Pharma has contaminated research and corrupted practice such that care has become progressively worse. This is the field of child psychiatry. As I have described in Suffer the Children, increasing numbers of children are being unnecessarily medicated for problems that can be resolved safely and effectively with family therapy and other talk therapies. Many of these drugs are prescribed "off label" to children, and their risks and side effects are not always adequately explained to parents.

Big Pharma not only influences psychiatrists to prescribe their products to children, but they also influence the creation of DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnoses that call for treatment (in the eyes of DSM panelists on their payrolls) with their most profitable drugs. As a family therapist, I am constantly appalled by the number of psychotropic drugs that have been prescribed to the young people who come to my office. These children are sedated and fatigued by the drugs and, despite larger and larger doses, their problems have only gotten worse.

In the field of children's mental health, legislation that requires physician transparency is long overdue and should be welcomed by doctors who remain true to their Hippocratic Oath to do no harm, and who have nothing to hide.

For more by Marilyn Wedge, Ph.D., click here.

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