Vermont requires publication of drug company payments to doctors; Medtronic rebuked

In the absence of meaningful regulation at the federal level, states have begun to act to achieve greater transparency in the relationship between medical manufacturers and doctors.   Vermont took the most meaningful step thus far, with the Vermont legislature adopting a statute that requires drug and medical device manufacturers to publicly disclose all payments to physicians or health care providers.  It also bans all free meals.  While a drug industry spokesman claimed the legislation would be "onerous" for doctors, it was supported by the Vermont Medical Association, which represents 65 percent of the state's doctors.  It is explected that the Governor will sign the act into law next month.

The State of Minnesota was the first to begin requiring pharmaceutical companies to disclose payments to doctors.  Minnesota's disclosures created significant embarrassment for a number of manufacturers and physicians, particularly psychiatrists.  (Information on these disclosures can be found in earlier entries on this web log.)  Massachusetts has also adopted less comprehensive regulations.

Vermont's Attorney General issued a report last month, indicating that in 2008, makers of medical products spent about $2.9 million dollars on marketing to health care professionals in Vermont.  About half of all licensed practitioners received compensation, with doctors in half a dozen fields receiving compensation in excess of $100,000.00.  About $1.8 million was paid to only 100 doctors, suggesting that more influential practitioners were targeted for larger payments.  A spokesman for the Vermont Association for Mental Health questioned "If the drug industry gives $3 million on average for three years now to physicians in a small state like Vermont, what is happening in California and New York?"

"What is happening" is doctors are being paid literally billions of dollars to influence their prescribing practices, in a manner that drug companies don't want light shed upon.  Doctors and hospitals are choosing medications and medical devices in part based on who gets paid how much for "consulting" or "lecturing" on the use of the products, in thinly-disguised bribery schemes.  If the consulting, research, educational and endorsement schemes utilized to compensate doctors are legitimate, they should stand up to scrutiny by patients, hospitals and third-party payors including the government.

In a related development on the same day, Medtronic announced that it was discontinuing its relationship with Dr. Timothy Kuklo, Orthopaedic Surgeon who apparently published fraudulent research; and Senator Chuck Grassley, Republican from Iowa, rebuked Medtronic for omitting Kuklo from its previously-published list of paid consultants.  Kuklo published research attesting to the effectiveness of a Medtronic product, while an Army doctor stationed at Walter Reed, without securing proper consent or disclosing his research to the Army or the hospital.  Turns out he apparently falsified that research--now withdrawn by the journal that published it--and neither he nor Medtronic disclosed that he was being paid by the company.

Kuklo is now in private practice in orthopaedic surgery in St. Louis and on the faculty at Washington University.  He apparently refuses to discuss the matter with reporters.  He is now acknowledged to be a paid consultant for Medtronic both on Infuse--a bone growth product--and spinal devices unrelated to Infuse.  Reportedly, Kuklo's patient numbers in his published research do not match Walter Reed's records, and the other physicians whom he reported as co-authors have repudiated his claim.  He has apparently made a regular practice of endorsing Infuse without disclosing his own financial ties to the company. 

Transparency would be a good thing.  Thank you, Minnesota, Vermont and Senator Grassley.