John Oliver returned to the airwaves Sunday night, setting his targets on the tens of billions of dollars that drug companies spend marketing directly to physicians each year to get them to prescribe their products.
These financial relationships have long been known, but there's been little transparency on how this world operates. But as Oliver rightfully points out, there is new federally mandated transparency on how Big Pharma and medical device companies market to doctors.
There's one important thing that Oliver left out, though — the Web site doesn't work all that great, at least not yet.
Because of a provision in the Affordable Care Act, you can now use a government-run database to see how much drug and medical device companies pay doctors for consulting fees, travel junkets, free turkey sandwiches, clinical research and more — any payment worth at least $10. When the Open Payments database launched in September, we found out that these firms paid at least $3.5 billion in marketing to doctors between just August 2013 and December 2013. These dollars were shared by 546,000 individual physicians and 1,360 teaching hospitals.
Oliver urged viewers to go to the Open Payments database, which is maintained by the federal Centers for Medicare and Medicaid Services, to look up their doctors. Here's an example of what they might find reported on the site if they type a doctor's name in:
What Oliver didn't mention, though, is that this federal Web site hasn't been without its own significant troubles. When CMS launched it at the end of September, about 40 percent of the reported payments had information identifying specific doctors stripped because of problems with the data. An additional 300,000 records were withheld at the time because they hadn't been verified.
"That's still essentially the status quo," said Allan Coukell, senior director for health programs at Pew Charitable Trusts.
The database is rife with errors, according to ProPublica, which has long been reporting on the financial ties between pharma and doctors. The investigative journalism outlet discovered spelling errors (one company spelled its own drug incorrectly nearly 1,000 times), some payments for a specific drug were reported under multiple names, and that some files didn't include product names. CMS didn't double-check the data submitted by the companies, ProPublica found. Still, the outlet discovered some trends in the data, like drugmakers spending mostly to market "me-too" drugs, as opposed to innovative treatments.
The information is expected to improve over time, though, and will be regularly updated with new data. The first major update is scheduled for June, when all of 2014 payments will be reported, and the missing information from 2013 will be filled in.
"You're limited by what you can conclude right now because so many records haven't been published," Coukell said.
Also, the fact that a drug company either paid for your doctor's sandwich, or flew him or her out to an industry conference isn't proof alone that your doctor is being improperly influenced by a drugmaker.
"The point is, there is information on this database you should know, and this should really be just the beginning," Oliver said on his HBO show.
A 2008 survey from the Pew Prescription Project found about four in five patients thought drugmakers' gifts were influencing their doctors' drug prescribing habits. But just 34 percent said they were likely ask doctors about potentially troubling financial ties.
Asking about drug company payments is a potentially awkward conversation to have with your doctor. But perhaps this new database will make it easier for patients to ask the uncomfortable questions.
This post has been updated.