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The Big Pharma Transparency Report Card: Congratulations, Merck. Lilly? Needs Improvement

Pfizer (PFE)'s disclosure that it paid $20 million to 4,500 doctors in consulting and speaking fees is a welcome development, but it's not perfect. A comparison of Pfizer's disclosure with those of Merck (MRK), GlaxoSmithKline (GSK) and Eli Lilly (LLY) shows that the way Pfizer has provided the information makes it difficult to download and impossible to see why doctors received the fees they did.

That information was provided in Merck's disclosure of the same information -- proving that it can be done. Merck's list is the most transparent so far. Lilly's list -- published as an image so the text within it cannot be copied -- is the least transparent.

Here's a ranking of how transparent the disclosures are, based on whether the lists are searchable, downloadable or sortable:

  1. Merck Downloadable? Yes Searchable? Yes Sortable? No By brand? Yes
  2. GSK Downloadable? Yes Searchable? Yes Sortable? No By brand? No
  3. Pfizer Downloadable? No Searchable? Yes Sortable? No By brand? No
  4. Lilly Downloadable? No Searchable? Yes Sortable? No By brand? No
(Note: the designation "by brand" includes whether the disclosure lists the business or disease category in which the doctor consulted.) The disclosures are important because patients don't realize that most doctors in the U.S. have a financial relationship with a drug, device or healthcare company. Companies want financial relationships with doctors because they work -- friendly ties influence prescribing behavior, which can make or break a blockbuster brand.

Non-sortable or downloadable disclosures make it extremely difficult to sift the data for specific doctors or patterns in drug company payments. It is impressive, for instance, that the St. Petersburg Times found two Tampa surgeons who were involved in a botched surgery that killed a high school teacher and one who brain damaged a patient during sinus surgery, leaving the patient paralyzed and blind. The paper's investigation required comparing Lilly's list with stated medical board records. Not an easy task.

All four companies should be praised for publishing these lists. But why have only four companies bothered? One reason is healthcare reform. Buried within President Obama's bill is the Physician Payment Sunshine Act, which requires a national online database of all this information by 2013. An unintended consequence of the act may be that most companies will look at that deadline and conclude, "We'll get to it in three years."


Image from Flickr user somegeekintn, CC.
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