Should the Sunshine Act be celebrated?

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are in luck.

As the August 1st, 2013 deadline to start reporting information about these sorts of transactions approaches, doctors and hospitals are reevaluating whether a free tray of chicken salad wraps is worth the scrutiny.

The Sunshine Act, a provision of the Affordable Care Act (aka Obamacare), requires companies that make drugs, medical devices, and biological medicines to report payments and items of value given to physicians and teaching hospitals. (specifics outlined by NEJM and AMA)

Additionally manufacturers and group purchasing organizations must report certain ownership interests held by physicians and their immediate family members. It seems like physicians who own stock in a publicly traded pharmaceutical company do not have to report these shares, as they are generally available to everyone and are considered an “exempt” interest. But other terms of ownership and investment interest must be disclosed, including the dollar amount.

A transfer of anything between a company and a physician that has a value above $10 must be reported. Cumulative gifts totaling $100 or more over a year must be reported.

(One way a sneaky physician might find a loophole in this regard would be to ask the drug rep who comes to the office for a lunch time meeting to bring just one hot dog, valued at $9.99. This would fly under the radar… at least 10 times per year – but if the total cost of the hot dogs brought into the doctor’s office exceeds $100 for the year, said hot dogs must be reported. One could then log on to the Medicare website and see how the 11 hot dogs your doctor ate over the year totaled $109.89, which carries multiple degrees of shame.)

The Sunshine Act will expose or stop many physicians from making additional money through relationships with manufacturers that represent a conflict of interest.

It will also represent another dreadful use of the word “sunshine,” and makes for great irony as our government increasingly operates in darkness.

The threat of public shame and public misunderstanding will also create fear among physicians, and new treatments and medications will go unnoticed without the occasional lunch used by drug reps and physicians to communicate.

I’m looking forward to less patients assuming I go golfing for free, or thinking I get taken to Las Vegas for a free convention every year.  This has been outlawed for some time.

Office morale will plummet in many locations that used to host drug reps for lunches, occasionally or daily. The medical assistant who used to look forward to getting a free eggplant parm with arugula salad once a week (as her doctor learned about a new blood pressure medication) may now be upset. A lot of mom and pop restaurants will see fewer business lunches purchased by drug reps, and more fancy dinner venues will see a decline as well.

In any other facet of the American economy, the “business lunch” is revered as an opportunity for communication, networking, and an exchange of new ideas. In medicine it has been cast as a seedy chance for manipulation, kickbacks, and brainwashing, and is now subject to the sanitizing UV radiation of “sunshine.”

If we as physicians are to be held to such monastic, ascetic terms of engagement with the business community, then fine. I’m all for keeping drug reps carrying trays of chicken nuggets away from the office.  I’m all for those few specialists and physicians who are much too cozy with pharmaceutical companies getting the public scrutiny of their speaking fees and other arrangements. But then everyone else butt out, too.

Insurance companies paying CEO’s hundreds of millions, malpractice clients and their lawyers getting paid millions, overpaid health care administrators emulating corporations, and third party profiteers of all stripes … everyone out.

The examining room should be about a doctor and a patient, with the unfortunate reality of the economic exchange feeling no more corrupt than payment for a bag full of groceries.

“Dr. Charles” is a family physician who blogs at The Examining Room of Dr. Charles and The Green Examining Room

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  • rtpinfla

    1,000 times yes to the last 3 paragraphs.

  • Daniel

    I hope that the Sunshine Act will help reduce the influence of industry in teaching hospitals where students and residents are coerced into attending industry-sponsored activities.

  • Suzi Q 38

    I used to have cases of calendars, jars, wooden boxes, clocks, pens, tourniquets, cardboard organizers with handles, paper weights, paper clips, huge clothespins….all with drug names on them. I may still have a few of these relics. Maybe there will be a spot in the Smithsonian for them someday.

    Nurses and pharmacists loved the CME credit presentations and lunches. We had to provide them for FREE, and we brought the lunch.
    Planning one of these gigs at the first tier hospital took a couple of weeks. It was usually over with in 40 minutes and everyone was fed for free. I took home the leftovers to our family, LOL.

    Some of the more social doctors would see us reps go to lunch and ask if they could join us. We had to say “yes.”

    The funniest luncheon was after a phone conference with a physician speaker from New York. The doctor spoke to all of these locations at clinics across the U.S. one day during lunch. Apparently, he was quite famous. The clinic I was at had several residents in attendance. They asked a lot of good questions, so they made me look good to my boss.

    I appreciated that, so I took them all to a decent lunch. It was not very expensive, but the restaurant served good food.

    Anyway, some residents did not make much money, so they were ordering quite a bit. The chief resident excused himself, then ordered some food to go as well. Not to be outdone, a couple of others did the same. Ironically, they were quite embarrassed when I got the bill.

    I looked at them like they were errant children, but I just had to laugh.
    That was the first time that I realized that residents did not receive the regular physician pay yet.

    I never let it get out of hand again. I remember taking other residents out the next time, but telling the food server NOT to allow any orders to go…She looked at me like “Are you kidding me???”

  • ninguem

    When I go to medical-legal meetings…….really legal meetings with a few doctors with interdisciplinary interests…….

    … should see the goodies the reps hand out.

    The case investigators, transcriptionists, court reporters and various recording services, all the services that support the lawyers.

    They’re giving out expensive single-malt scotch, all sorts of high-end goodies.

    But buy a doctor a sandwich, and the world is coming to an end.

  • Sunjay R Devarajan

    Hang on a second, all this law states is that such transactions must be REPORTED, not outlawed. If you feel like you want to proceed with drug rep lunches and learn about new medications through those means, then you are free to do so. It will just be publicly available information. If there is actually no shame in what you plan on doing, then you should have no shame in people coming to know about it.

  • Guest

    Nope. Another slapping of the hand of physicians and accusing them of wrongdoing. Congratulations! You people have completely crushed the joy out of medicine. Now apparently 11 hot dogs per year provided by big pharm is reason for public stoning. Jeez.

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