Linking Doctors and Drug Makers
One of the many changes brought about by the health care laws has been new requirements on nearly all manufacturers of drugs and medical products to report payments or gifts made to doctors and teaching hospitals. The data has been made public in an online database in a push for greater transparency around doctors’ financial interests. Although such financial ties between medical, especially pharmaceutical, companies and politicians are widely known, it is interesting to think about the analog of lobbying doctors. Some reports have shown that doctors that have relationships with industry are more likely to prescribe expensive or even inappropriate drugs. There are, however, important financial ties based on doctors providing consultation, clinical trials and research to companies, additionally, a significant portion of payments are often royalties for products. Furthermore, the database has been riddled with inaccuracies and the information is skewed because companies are allowed to delay reporting research payment details for new products.
Errors in the data notwithstanding, how much can the network of financial payments reveal about questionable financial interests the contexts of the transactions are missing? The data from the database has three broad categories, general payments, research payments,a and physician ownership information. Both research payments and ownership payments would likely have no direct connection to questionable financial interests so the focus should be on general payments.
One way to interpret the data would be through a sort of collective filtering on doctors who are connected to the same company by similar sorts of connections (ie similar amounts, frequency…). If a company can be characterized as often making financial payments in an effort to persuade prescriptions, the doctors can similarly be connected with dishonesty. In the same way, doctors characterized as having conflicts of interest in the prescriptions of one company can also have their network examined such that other companies connected to them are considered questionable. To characterize companies or individuals, one could look at details surrounding transactions such as the time and frequency during which they are made. Even without the information of the prescriptions doctors actually made, there are many conclusions that can be drawn about their financial interests in companies.
It is clear that doctors realize how dangerous the implications of payments from companies can be. The article describes one doctor who scrutinized his records and also deliberately skipped lunches provided by drug companies. The powerful nature of the conclusions that can be drawn from the data makes it all the more important to avoid labeling innocuous behavior as unethical so it is likely that the network derived from the company payments will need to be qualified with more information to characterize the connections for greater accuracy.
Sources:
http://www.cms.gov/OpenPayments/Explore-the-Data/Data-Overview.html