In the dark on doctor perks

Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient’s condition. The doctor’s motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor’s participation in an experiment might compromise his medical advice.

A provision of the 2010 healthcare reform law should bring new transparency about these and other corporate payments to physicians — including lavish dinners, gifts and industry-sponsored conventions that are more luxury vacations than medical conferences — by publishing the information in an online database. But the final regulations to implement the Physician Payment Sunshine Act were supposed to be published in October 2011; the database was supposed to go live later this year. Instead, the regulations are 15 months overdue.

As with the new food-safety act regulations — most of which were finally released in January, a full year past deadline — the sunshine rules have been drawn up by the appropriate agency but have been held up by the Office of Management and Budget. One theory for the delay, advanced by critics of the administration, is that President Obama wanted to avoid issuing regulations during election season, when the extent of government’s reach was a contentious issue. That would be a poor excuse, if true. In any case, the election is over; at this point the delay smacks more of bureaucratic inefficiency than political expediency.

Most physicians put their patients’ well-being first, but a study showed that doctors who receive food from a company are more likely to prescribe that company’s products, even though they might not be doing it consciously.

The sunshine act isn’t as strong as it should have been. Ideally, doctors would be the ones doing the divulging, making information about payments and gifts they have received readily available in their examining rooms. Not all patients will know about the online database or possess the savvy to use it. But the rules nonetheless are expected to influence behavior; public disclosure will make both physicians and drug companies more circumspect.

One question in the minds of consumer advocates is how much disclosure will reveal. For instance, if a company gives a doctor a large sum to lead a drug trial and that doctor spreads the money among other physicians who enroll patients, it’s unclear whether those payments would be reported as coming from the drug company. The administration should release rules that fully reflect the spirit of the law, and it should do so soon.