Eli Lilly and Co. says it will begin disclosing how much money it paid to individual doctors for advice, speeches and other services.
The drug company's move, an industry first, comes as members of Congress push a disclosure bill in an effort to prevent such payments from improperly influencing medical decisions.
Beginning next year, Eli Lilly will disclose payments of more than $500 to doctors for their roles as advisers and for speaking at educational seminars. In later years, the company will expand the types of payments disclosed to include such things as travel, entertainment and gifts.
Some have voiced concerns that doctors are influenced by these payments in their treatment decisions and that this in turn can drive up medical bills. Although most physicians believe that free lunches or trips have no effect on their medical judgment, research has shown that these types of payments can affect how people act.
“The ethical handwriting is on the wall. Disclosure is coming. States are pushing for it, and once a few states do, it's hard to imagine the federal government won't line up behind,” said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. “I think that's a good thing because we have a great deal of empirical evidence that gift giving can influence behavior in terms of prescriptions, publishing positive findings but suppressing negative findings, and generating enthusiasm for new drugs.”
Eli Lilly was also the first drug company to publicly report its educational grants for medical conferences. Dr. John Lechleiter, president and CEO of the company, said that made good business sense for the drug industry.
“We've learned that letting people see for themselves what we're doing is a good way to restore trust,” Lechleiter said.
In the past two years, lawmakers in Congress introduced bills that would require drug and medical device manufacturers to disclose any payments to doctors exceeding $25, but the industry chafed at the strict reporting threshold. Eli Lilly had announced earlier that it intended to comply with key aspects of the legislation once some lawmakers agreed to a higher reporting threshold of $500.
Eli Lilly's disclosure of payments to doctors will begin in the second half of 2009, and will cover payments made in the first half of the year. The company doesn't plan to report payments from 2008 or earlier, noting that the legislation before Congress also did not contemplate such a look back. Gradually, the company plans to expand its registry to incorporate all payments that the Physician Payment Sunshine Act would require to be made public.
Lechleiter said that physicians who advise the company or speak at conferences about their experiences in treating patients take time away from their medical practice and need to be compensated at fair, market rates.
Dr. Peter Lurie, deputy director of the health research group at Public Citizen, said state laws can let patients know when their doctors have a connection to a drug firm, but the laws have various exemptions and sometimes don't even disclose the information to the public, he said.
Lurie was skeptical that Eli Lilly's announcement represented a step forward.
“There are dozens of pharmaceutical companies. This is just one of them. Most won't follow this guideline at all, and there will be no enforcement,” Lurie said. “This is Ely Lilly's attempt to forestall the federal legislation by saying we're in effect complying anyway.”