Saturday, February 19, 2011

Physicians should separate themselves from the pharmaceutical industry

(originally posted at the National Physicians Alliance blog February 19, 2011)


One of the National Physicians Alliance’s guiding principles states: “We place the best interests of our patients above all others and avoid conflicts of interest and financial entanglements. The health of our patients is our first concern.”  One of the most evident examples of fulfilling this commitment is the Unbranded Doctor campaign, which aims to remove pharmaceutical company (PhRMA)  influence from physicians’ practices.

There are arguments made that not all PhRMA influence is harmful.  Some argue that medication samples provide benefits and allow patients to save money.  Others–often physicians–claim that speaking on behalf of PhRMA allows them to discuss the benefits of certain medications and treatments (even though deeper investigation indicates that employing physicians as speakers may simply provide another avenue for PhRMA to change phycisians’ prescribing patterns).  However, there is research that physicians can be influenced by PhRMA and other industry contacts, and that this influence might not be noted by the physicians themselves.  Now, there is a more direct reason for physicians to avoid PhRMA payments: they undercut patients’ trust.

ProPublica and Consumer Reports carried out a survey investigating patients’ perspectives regarding physicians who accept PhRMA payments.  The survey indicates that patients are largely unaware of the nature of physician/PhRMA contacts, and 74% of survey respondents disapprove of physicians taking payments for promoting medications to other physicians.  Furthermore, 95% of respondents noted that their physicians had not disclosed any PhRMA payments, and 70% thought that physicians should disclose that information (a legal requirement coming soon thanks to the Physician Payments Sunshine Act provisions included in the Patient Protection and Affordable Care Act).  Finally, the survey shows that a majority (51%) of respondents felt that payments as low as $500 could influence a physician’s judgment.

As professionals, physicians are held to high standards.  These include the obligation to ensure that our recommendations for treatment are free of bias and in each patient’s best interest.  Research indicates that PhRMA and industry contacts introduce bias into physicians’ decisions that may not benefit patients, leading one to wonder whether any level of PhRMA or other industry contact is ethical.

Physicians’ decisions to work with or take money from PhRMA is largely unregulated (except by voluntarily codes of conduct) and largely outside the public’s view.  In theory, physicians can continue taking PhRMA payments as long as we like.  However, we should hold ourselves to a higher standard.  We know our patients do.

Monday, February 14, 2011

Why this matters for Virginia

(Originally posted on the National Physicians Alliance blog February 14, 2011)


Since you found this page, I presume you know something about National Physicians Alliance (NPA)'s efforts at the national level to improve access to health care, to reduce the influence of PhRMA and industry on medical care, and to further the causes of fairness and justice in our health care system.

In Virginia, these efforts will be even more important. Our current political leadership did not support the passage of the Patient Protection and Affordable Care Act (ACA; aka "health care reform"). Our current Attorney General, Ken Cuccinelli, takes great pride in the fact that he has sued the federal government to overturn the ACA's individual mandate--a step that will undercut many of the popular insurance company reforms the ACA instituted and that would drastically reduce the law's effectiveness. Meanwhile, in 2010 Virginia’s General Assembly passed a law that aims to exempt Virginians from the ACA’s individual mandate.

It is clear that Virginia, through our state government, will be a battleground state in the current legal challenges to the ACA. It is perhaps fitting, in this 150th anniversary of the start of the Civil War, that we Virginians find ourselves discussing the ideas of states’ rights versus the authority of the federal government. Once again, it will likely be a long and drawn-out struggle, but one that will have a tremendous impact on our nation’s future.

If you would like to work with NPA on these important issues, please join NPA nationally, and please join the local Virginia network focused on addressing these issues in the Commonwealth. Please contact Becky Martin from the NPA ( to let her know of your interest, and welcome to the team!

What does the public *really* think about healthcare reform?

(originally published on the National Physicians Alliance blog on February 14, 2011)


The debate surrounding the Patient Protection and Affordable Care Act (PPACA) has been marked by misinformation and dishonest rhetoric by those who opposed the law’s passage and who now oppose its implementation. Over the last 6 weeks we have heard much about how much the public supposedly opposes the law, and how anxious the public is to repeal the law wholesale. This is another example of exaggeration, as evidenced in this article. The article indicates that if given only an up-or-down option, more Americans would vote to repeal than to keep it. However, if the polls include additional options, the true public feeling is evident. In one poll, approximately ¼ of those who favor repealing the PPACA do so because they do not feel the law went far enough in its reforms. Another poll shows that approximately 1/3 of Americans would repeal the law, 1/3 would like to expand it, and about 20% would prefer to keep it the same. These results are very different from the current House of Representative’s leadership’s claims that their vote to repeal the law was based on the public’s opposition to the PPACA.

The above article also indicates that the House’s plan to attack the PPACA by de-funding the law is unpopular. In a Kaiser Family Foundation poll, 62% opposed de-funding the law. With that information, it is good to see the PPACA’s reforms being implemented despite its opponents’ rhetoric. Starting on January 1st, provisions providing a boost in Medicare reimbursement for some primary care physicians and general surgeons and a requirement that health insurance plans spend at least 80% of patient premiums on providing care have gone into effect.

As the public and physicians continue to see benefits from the PPACA, the law will become increasingly popular and accepted. In the meantime, it would be nice if the law’s opponents would tone down the exaggerated rhetoric. Both supporters and opponents of the PPACA agree that the law needs adjustments—we should be working together to strengthen the law and ensure access to health care for all.

Saturday, February 5, 2011

How would the House replace the healthcare reform they repealed?

(Originally posted on the National Physicians Alliance blog January 23, 2011)


Somewhat lost in the fuss around the House of Representative's actions to repeal the Patient Protection and Accountable Care Act (PPACA) was the fact that the House's Republican leadership actually submitted its own proposal for reforming health care.  Last year, now-Speaker John Boehner sponsored an amendment to H.R. 3962 (the "Affordable Healthcare for America Act").  This is currently the only legislation the GOP has submitted to take the place of the PPACA, and therefore it is important to see what this alternative offers.

Fortunately, the Congressional Budget Office (CBO) has completed a preliminary review of the Speaker's proposal.  As it currently stands, the supposed replacement for the PPACA will make minimal changes in the current state of the United States health care system.  The proposal would reduce insurance premiums in the large group market by 0-3%, and by 5-8% in the individual insurance.  The proposed legislation would also reduce the number of non-elderly Americans who lack insurance by 3 million people between 2010-2019 (leaving 52 million non-elderly Americans uninsured).

To do this, the proposal would reform insurance markets by allowing insurers to sell products across state lines.  This would allow the state with the most lenient requirements to essentially dictate the market, as the cheapest plans with the fewest benefits would appeal to employers and others attempting to reduce costs.  The plan would also reform health spending accounts and work to enact malpractice tort reform.

Nowhere in the plan is there any indication of reforming insurance company practices of denying care on the basis of preexisting conditions, or of ending the policy of rescinding health coverage once an individual starts making use of the coverage they purchased.  Nor does the law continue such popular provisions of the PPACA as closing the Medicare Part D "doughnut hole" or allowing parents to include adult children on their insurance until age 26.  These are provisions that have broad popular support, and that the Republican-controlled House took away when they voted to repeal the PPACA.
As it stands, the proposed replacement for the PPACA would be laughable if it weren't so sad.  The proposed legislation would undercut numerous patient protections from insurance company misconduct while doing nothing to increase access to health care and making minimal changes in the cost of obtaining health insurance coverage.

It's a good thing that the PPACA is still law, and will remain law, despite the House's symbolic vote for repeal.  The alternative would be a disaster.