Q&A: It's Not Just Doctors Who Get Company Money And Gifts

"The industry will market to anyone who has the ability to prescribe to a patient," she said. In the database are "many non-physician prescribers who received a lot of gifts."

Q: So whom are we talking about here? Physicians' assistants and nurse practitioners?

A: The database also provides information on Registered Nurses, Licensed Practical Nurses, Pharmacists, Dentists, Licensed Psychologists, Massage Therapists, Nurse Anesthetists, Nurse Midwives, Physical Therapists, Psych. Clinical Nurses, Respiratory Therapists, and Speech Pathologists

Q: What's your sense of the numbers and sizes of the gifts and payments they receive, as compared to physicians?

A: In terms of gifts received, the non-physician prescribers received $ 3,521,879.71- this is just about 18% of the total amount paid to individuals (the rest was to physicians).
Over 3,000 non-physician prescribers received nearly 4,000 gifts and payments by industry. This compares to over 8,800 physicians who received over 18,000 payments and gifts.
Industry marketing to these individuals is significant and has grown dramatically over the past 10 years.

Q: What is your advice to a patient who looks up a non-physician provider who treats them and finds that the database does show that gifts or money have changed hands?

A: Patients should talk with their provider and ask them about it- especially if the patient is using a device or taking a drug by the company that gave their provider a gift. Patients should be confident in any provider's ability to give them conflict-free care.

Q: Is there any research on whether non-physicians are more or less likely to be affected by a gift, and change their prescribing patterns?

A: I have not seen any research indicating non-physicians are more or less likely to be affected, but there is a significant amount of evidence that demonstrates that all humans reciprocate when they are given gifts. Often, when a provider receives a gift from a company, the prescribing patterns change. Research also shows that more frequent, smaller gifts engender a stronger bond between humans resulting in behavior changes. This is why industry sales representatives will make multiple visits to providers during a year — to foster the relationship.

Q: You say the federal law on disclosure of gifts and payments to health care providers does not include non-physicians. Why is that? And does that worry you?

A: The Physician Payment Sunshine Act, which is the federal disclosure law, only requires disclosure of payments and gifts made to physicians and teaching hospitals. The Massachusetts data shows that drug and device companies spend time and money marketing to all prescribers because it is a good return on investment for them. We would like to see as much disclosure as possible so that patients can engage their providers in discussion about potential conflicts of interest.

This program aired on November 23, 2010. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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