Star Tribune
January 25, 2009

Without question, 2008 did much to erode public trust in health care. Among last year's lowlights: revelations that pharmaceutical companies ghostwrote medical research and shelled out big-buck consulting fees to top physicians who then leveraged their prestige to tout certain drugs.

Efforts to rebuild that broken trust are off to a promising start this year. Last week brought two initiatives on Capitol Hill and in Minnesota that are designed to make the medical industry more accountable to the public. Both boldly tackle the ticklish topic of physicians' financial ties to drug and medical device industries.

On Thursday, Midwestern senators announced a renewed push for a federal law requiring greater disclosure of payments to doctors. The aptly named "Physician Payments Sunshine Act of 2009" -- championed by Sens. Charles Grassley, R-Iowa, Herb Kohl, D-Wis., and Minnesota Democratic Sen. Amy Klobuchar -- takes a cue from a pioneering 1993 Minnesota law requiring disclosure of most pharmaceutical payments to physicians. The Sunshine Act would broaden this requirement and make it national. All payments of $100 or more from drug, device and biologic firms would be reported to the U.S. Department of Health and Human Services, which would compile this information and make a national database accessible online to the public. The proposed legislation, which languished in the last congressional session, also has teeth: It calls for penalties of up to $1 million for deliberate failure to report the information.

"This is common-sense legislation that will help ensure the integrity of our health care system," said Klobuchar. "This will shine a light on how health care decisions are made and make sure that patients can trust that what they are prescribed is based on science and the facts, not special interests." Kohl, in a statement, said he is confident the legislation will pass this year.

The momentum toward more transparency continued in the Twin Cities, with an unexpected announcement this week by Park Nicollet Health Services. Instead of waiting for new disclosure laws, Park Nicollet's leadership decided to take action. The health care system now requires public disclosure of its medical staff's financial ties to industry. Payments to everyone from doctors to physical therapists are now listed on the health care system's website. It's an extraordinary and praiseworthy step. Park Nicollet joins the prestigious Cleveland Clinic as one of the few big medical institutions nationally to make this information so easily accessible online to the public -- though many medical centers do provide this info during individual office visits or on request from patients.

Park Nicollet's Chief Financial Officer Dr. Samuel Carlson said the move was not a reaction to any proposed disclosure laws. Instead, he said, leaders felt it was a proactive step toward maintaining patient trust in providers. "I think the Web access will stimulate conversation,'' Carlson said. "It is also a message to all of our credentialed staff. Disclosure is an important thing to do.''

It's important to note that these financial ties are not inherently bad. Cooperation between doctors and industry plays a critical role in developing and perfecting new drugs and medical devices. But there's an extraordinary amount of money that's exchanged and legitimate concerns about the influence it may buy. Minnesota medical staff received $57 million from drug firms between 1997 and 2005. An additional $47 million went to medical clinics or organizations. Patients deserve better access to this information and should take advantage of it in making care decisions. Legislation like the Sunshine Act is overdue. Until it's passed, medical centers would do well to follow Park Nicollet's proactive example.