Eli Lilly draws back the curtains
Five hundred dollars won’t buy you a heck of a lot these days. It will pay for one of: a new set of medium-quality all-season radials; a pair of mediocre tickets to see the Buffalo Bills in Toronto; or, birthday dinner at a nice restaurant for the missus and her parents, before you factor in parking and the babysitter.
    If you’re a physician, however, 500 bucks will get you something special next year, and that is entry into the new  data base Eli Lilly is setting up, to disclose honoraria and grants. The company recently announced it will likely begin revealing to the public the identities of doctors who receive any form of payments or incentive valued at 500 smackers or more, around Q3 of 2009. The registry will be accessible to all, through a web site.
    This is a significant departure from previous pharma industry practices. As Lilly CEO John Lechleiter says, “I think there is an element of risk at being the first.” Dr. Lechleiter may be slightly overplaying the hazard. A number of US states have already enacted legislation requiring disclosure of drugmakers’ payments to doctors, and the US Senate is likely to sanction laws under the proposed Physician Payment Sunshine Act before 2011. More transparency regarding the relationships between Big Pharma and doctors is inevitable; Dr. Lechleiter volunteered to make his company’s records public only slightly in advance of being compelled to do so by law.
    Nonetheless, in this matter, Lilly led. Merck quickly said it will follow, and also plans public disclosures next year. AstraZeneca and Johnson & Johnson, both of which previously voiced support for aspects of the Sunshine Act, seem inclined  to adopt the practice. So, too, does Pfizer, which earlier announced plans to make public some details of its funding of CME events, as well as a plan to post additional drug safety information on the company’s web site.
    Other companies are taking time to consider the implications of laying bare the details of their financial relationships with individual practitioners. It isn’t difficult to envision that some thorny areas may be exposed, as when Dr. Henshaw determines that his classmate Dr. Paparelli has been receiving six thousand bucks each month in advisory board fees, while he, Dr. Henshaw, only got a one-time grant of five c-notes to attend a regional opinion leaders’ meeting in Halifax. It’s bound to strike him that Paparelli barely graduated from med school, owing only in part to that after-hours incident in the anesthesia lab. At the time, the assoicate dean arranged for the record to be expunged, explaining that Paparelli’s steady hands and keen coordination would benefit the entire community one day. But could anyone reasonably ask Dr. Henshaw to quietly endure this new affront?
    Honoraria data bases will also become popular places for the public to browse, as have all manner of medical web sites. Some members of the public may attempt to cross-reference the data against their dealings with their MDs. Some will learn for the first time that the recommendation they once received from their doctor, that they might benefit from trying a particular therapy, may roughly coincide with some form of financial transaction between the maker of that therapy and their practitioner. In the famous phrase of Ricky Ricardo, some ’splaining will ensue.
    These actions suggest a new era in relations between physicians and drugmakers. Some uncertainties are inevitable and some discomfort will be possible, but we believe this development is long overdue.
    Much publicity has accompanied recent efforts by medical associations and industry groups in the US and Canada to rein in some of the perceived excesses in hospitality afforded to doctors in association with congresses, detailing and educational events. While there is scant evidence to validate that free steaks at Morton’s and complementary golf at Deerhurst ever directly influenced a single doctor to write a single scrip on behalf of any particular product, the new guidelines have served to quiet speculation on the subject. That’s a good thing.
    Uncharacteristically, the governments of Canada and its provinces have lagged behind the US in pressing for accountability in the form of a registry for physician honoraria. But it’s just a matter of time before our local legislators take note of the stateside development and begin to consider similar actions. That would be regrettable, if only because standards may be destined to emerge on a province-by-province basis, creating the usual inconsistent  patchwork of regulations that makes doing business in Canada a special challenge for multinational marketers. The solution would be for companies’ Canadian units to proactively adopt the Lilly approach.
    Notwithstanding that his actions come one step ahead of probable new laws, we are impressed with Dr. Lechleiter’s leadership and his insight into this issue. In his words: “We feel very strongly there’s a huge missing element in our business and industry’s business, and that is the trust and confidence of the public. When you don’t have trust, I don’t think you can expect that business to grow and thrive the best it can.” 
    He couldn’t be more right. To get our industry turned around, we need to begin by letting the sunshine in.