Conflict of Interest and Your Responsibility

By Daniel Clair, MD

An aspect of the Affordable Care Act (ACA) known as the Physicians Payments Sunshine Act (the Sunshine Act) requires drug and device manufacturers to report payments or transfers of $10 or more to physicians and teaching hospitals or any doctor providing care in a teaching hospital. The payments are listed on the government website at http://cms.gov/openpayments/.

Designed to make potential conflicts of interest more transparent, the act is well intentioned, but misguided. Concerns about the appearance or presence of conflict of interest have caused many physicians to become leery of any interaction with industry. As a result, drug and device manufacturers are struggling to find physicians and surgeons with expertise and experience to provide critical information and feedback.

The Sunshine Act website reports thousands of physicians who have received industry-sponsored support in amounts ranging from $10 to $25 million. It does not distinguish what these monies were for, or how they were paid. One physician who received $20 million is principal investigator of a national multicenter clinical trial, but it appears he received the money himself. Other individuals were compensated for patented ideas or licensed technologies, and that’s not specified either. Unfortunately, there’s no method to correct this.

However concerning this may be, you should know that most patients have no idea how to look up this information, and often, no desire to do so. At a recent speech to a patient group, I asked how many knew or were familiar with the Sunshine Act. About 50 percent raised their hands. Then I asked how many had looked up their physicians, and no hands were raised. This should mean that the likelihood of the Sunshine Act having a major impact on a physician’s reputation is small. That being said, you should be ready to discuss potential conflicts of interest and income from industry participation, should a patient ask.

Physicians in well-respected positions who are considered opinion leaders need to continue providing their services. Companies depend on us to ensure that research is done correctly. Otherwise, their products will not serve our patients well. You deserve to be fairly compensated. If you are concerned about the appearance of conflict of interest, forego the honoraria. But don’t be afraid to participate, because patients and industry need our support.

Daniel Clair, MD, is Chair of Vascular Surgery at Cleveland Clinic.