ProPublica: A valuable lesson on how not to run a transparency database

ProPublica: A valuable lesson on how not to run a transparency database

03.21.13 | By

I've been watching the news coverage of ProPublica's Dollars for Docs with disappointment. Why hasn't the media questioned the validity of conclusions drawn from numbers without context? Rather, many follow ProPublica's lead and paint an unsavory picture of collaboration between physicians and biopharmaceutical companies - armed only with figures and names. And then I read a Forbes column by Robert Radick. He dares to be skeptical about the database, saying its vagueness creates more questions than answers, and pushes back on "what apparently is intended to be a not-so-subtle wall of shame."

"Moving beyond such a superficial look into the complex relationships that exist in the medical industry, what is the genuine significance of all of this information? And does data about historical payments really shed any light on a doctor's professionalism, his or her commitment to patients, and the relationships between physicians, hospitals, and industry," said Radick.

Radick uses a couple of examples to illustrate just how murky a transparency database becomes without context:

  • "When a physician is shown to have received $10,000 for travel, what was the purpose of the trip? Did he or she go to the British Virgin Islands for a conference in which there was one hour of consulting and otherwise a good deal of snorkeling. Or, was the trip to China for the purpose of helping fix the cleft palates of orphans? The database offers no insight into these critical distinctions."
  • "When a doctor appears to have received $10,000 for speaking, was this amount paid for 20 separate talks given to clinics in underprivileged areas about the doctor's experiences treating a certain condition. Or, was the money paid for just one talk in which the doctor attempted to convince other physicians about the benefits of a specific manufacturer's product? Again, the database does not distinguish between these two very different types of payments. Thus, unless one views every single benefit given to and received by a physician or hospital as part of a cynical effort to influence the independent judgment of physicians, it is impossible to gauge whether any payments in the database are problematic, or instead appear to be reasonable, justified, and even beneficial for society as a whole."

Filling in the blanks and drawing your own conclusions can fuel the cynics (just look at Dollar for Docs) and there's no denying that those negative portrayals affect physicians. How would any of us feel about continuing to conduct work that was mischaracterized and tainted? The reality is that physicians play a vital role not only in researching and developing new medicines, but also ensuring patients have access to new medicines. Learning more about these complex collaborations is a very good thing and to do so requires that we be equipped with information - not just numbers. As CMS develops guidance on how the Sunshine database will look, we at PhRMA certainly hope they take this seriously. And until we have greater context, please visit Partners for Healthy Dialogues, which can help explain what ProPublica leaves out.

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