BMJ Editor’s Choice this week discusses two thought-provoking articles. ‘Doctors should tell patients who is paying them and why’ (Fiona Godlee)
In the UK, doctors are financially incentivised to provide specific tests and treatments according to the Quality and Outcomes Framework – but this sets up conflicts of interests. Dr Margaret McCartney and colleagues want patients to be able, easily, to find out what drug companies are paying their doctors, because there is evidence that those payments influence clinical decision-making: ‘Why the GMC should set up a central registry of doctors’ competing interests’ (BMJ 2014;348:g236) http://www.bmj.com/content/348/bmj.g236.
Leanna Wen, a physician in Washington, DC, ‘sees full transparency as part of ‘a renewed professionalism” and wants openness to include clarity on how doctors are reimbursed. ‘Patients need to be able to ask whether tests and treatments are being prescribed because they are in their best interests or because they benefit the doctor’, she says. Undeclared payments can amount to several million dollars in the United States and though doctors in the UK receive less, she mentions one who has been paid over half a million pounds by a drugs company. ‘Patients can’t trust doctors’ advice if we hide our financial connections with drug companies. (BMJ 2014;348:g167) http://www.bmj.com/content/348/bmj.g167
It may be that most doctors will receive far less and that many only receive monies from their employer, as suggested in the editorial – but how can we be sure?
‘Why did we ever think it was right for doctors to be involved in marketing drugs?’ asks Fiona Godlee. ‘Why not, for example, ask members and fellows to minimise such conflicts and require that they declare them?’
The two articles’ authors have set up websites where doctors can voluntarily declare their sources of income:
whosmydoctor.com and whopaysthisdoctor.org.
But should declaration be mandatory, as Leanna Wen suggests? And should the General Medical Council maintain annually updated declarations of interest alongside doctors registration details, as McCartney and colleagues would like them to?
Wen writes that she has received extreme hostility to her initiative from some doctors, but as Fiona Godlee comments, ‘declarations of interest are now standard practice for publication in medical journals. The same should be true for our dealings with patients.’