Saturday, January 21, 2012

Public acountability of health care dollars long over-due...

Editorial, New York Times, January 20, 2012
It took longer than expected, but the Obama administration is finally poised to enact badly needed regulations requiring that the manufacturers of drugs, medical devices and medical supplies disclose all payments they make to doctors or teaching hospitals. The information, which would be posted on a government Web site, will allow patients to decide whether they need to worry about any possible conflicts of interest.

 Such payments can be for legitimate research and consulting. But there is also a lot of cash being spread around to pay for doctors’ travel and entertainment or for gifts or modest meals for a prescribing doctor’s staff.
As Robert Pear reported in The (New York) Times this week, some prominent doctors and researchers receive hundreds of thousands or even millions of dollars a year in exchange for providing advice to a company or giving lectures on its behalf. About a quarter of all doctors take some cash payments from drug or device makers and nearly two-thirds accept meals or food gifts. Analysts contend that even seemingly trivial gifts can influence doctors to prescribe expensive drugs that may not be best for a patient’s health or pocketbook.
The new rules were championed by Senator Charles Grassley, a Republican, and Senator Herb Kohl, a Democrat, and incorporated into the health care reforms enacted in 2010. The reform law required the Department of Health and Human Services to establish reporting procedures by Oct. 1, 2011, and required manufacturers to start collecting the relevant data by Jan. 1, 2012. The proposed rules were finally issued on Dec. 14 and are subject to comment until Feb. 17, after which they will be revised and issued in final form.
The Centers for Medicare and Medicaid Services will publish the disclosure data on a public Web site that the law says must be searchable and understandable so that patients and advocacy groups can see which doctors are being paid and how much. Manufacturers could be fined up to $150,000 a year for failing to report payments and up to $1 million a year for “knowingly” failing to report
The new rules should give a welcome boost to otherwise spotty efforts by some companies, medical centers, scientific journals, states and ethical codes to eliminate, minimize or at least disclose financial interests that might cloud medical judgments. The existence of the Web site could deter some questionable payments. And it could help patients decide which doctors to rely on.
Not only did this legislation "take longer than expected"...it is at least 20 years late.
In Canada, one has to wonder if such legislation has even been contemplated by any jurisdiction.
There is an old adage in human affairs,"Not only must justice be done; it must be seen to be done!"
And the medical establishment, often if not usually and perhaps even always, under the protection of the legal establishment, has for too long been courted ravishly, it could be argued, by the pharmaceutical industry, and one has to assume the  medical supplies industry to use their favoured products in their treatment of patients.
Certainly, it is well established that post-graduate education, if any occurs at all, is funded by the pharmaceutical industry, "educating" the medical professional on the "benefits" and "possible side-effects" of their latest chemical creations, in the form of luxurious vacation-style seminars in the most desireable holiday locations, like Hawaii or some Caribbean Island resort, all of it paid for by the host companies.
Little wonder it might be difficult to "wean" those same doctors off their "need" to prescribe those same pills and potions whenever the opportunity presents itself. Certainly, doctors are not immune from being "influenced" in their choice of prescriptions. And with respect to the pharmaceutical industry itself, there are thousands of pharmacists whose "choice" of name-brand over generic drugs of the same quality and strength could easily reflect the favours bestowed on them by the producing companies.
And then there are the universities where medical research consumes billions of corporate dollars every year, and where do those dollars come from? Of course the companies who are the eventual beneficiaries of the research, producing precisely those products that the research says will "sell"... and oh yes, also be relatively effective.
There are too many inconspicuous cabals, unofficial and technically legal, that is within the existing laws, that depend on the unobserved, unaccounted and thereby unreported washing ashore of billions of dollars from the private sector, for what pass as "altruistic" ends, but which are really carrying considerable "self-interest" motivation and muscle.
The governments will soon have to convert themselves into ombudsmen for the citizens, if this practice is to be limited; it certainly will not be fully controlled or eliminated. And, in order to accomplish that end, the elected politicans will have to divest themselves not only of their stocks and bonds, their mutual funds and their credit defaults, but also those all-important campaign funds, coming again from the most needy corporate sources, that is needy of government "favours"....for the successful running of their corporations.
And it is long overdue for the public to demand public financing of all elections, thereby capping the tsunami of dollars "favouring" the advertising and public relations industries directly and the printing and broadcasting industries a little less directly.
If we are going to demand scrupulosity from the charitable foundations gathering cash for their research, there is no reason to stop short of the really big money bags, unless, of course, the political masters are themselves also the talking heads paid by those same money bags.
As an editorialist, on radio, in another life, I was removed from the "bully pulpit" of the microphone by a developer of a then peripheral retail shopping mall, because I was airing editorials supportive of his "downtown core" competitor, in the belief that the peripheral development would do much to erode the businesses already operating in the downtown core. "I will withdraw all future advertising dollars from your radio stations if Atkins is not taken off the air!" that developer informed the station manager, who conveyed the message to me. Clearly, the downtown developer was not coughing up as many dollars as those being threatened by the peripheral developer.
(The peripheral mall went ahead, as did the atrophy of the downtown core of a 50,000 population Northern Ontario city.)
Compared to the billions sloshing around out of sight, and thereby out of mind in the health care industry, into which some 20-30-40-50% of government budgets (at least in Canada) are directed, there is a serious need not to "tweek" the laws around the edges. The word "innovation" in the health care debate must include not only new technologies, and new methods of access, (like the "app" connecting patients with the doctors worldwide, instantly via the smart phone, for example) but also must include the monitoring of the confluences of influences that are marked with so-far unmarked cash.
The public, and that means the governments, must put their "mark" on those dollars, to avoid a drowing of the public purse in a headlong and headstrong commitment to provide "better" health care...regardless of that confluence of influences whose sources and recipients are now unnamed, unreported and undisclosed.

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