Monday, June 06, 2005


I'm trying to catch up after a busy weekend, and there is a lot to catch up on...
Last week in the Hartford Courant, an op-ed article entitled "Medically Unnecessary" offered an ear, nose and throat surgeon's heart-felt complaints about the brave new world of practice dominated by managed care.
In particular, he recounted how his practice tried to negotiate with a prominent insurance company. As a prerequesite to negotiating, the company sent the doctors a "confidentiality contract," which included penalties up to $100,000 per person for any "breach of confidentiality, [decided] solely at the insurer's discretion." The doctors refused to sign.
Here is another example of the secrecy rampant in US health care. Earlier, we had posted about how hospitals keep their often stratospheric "list prices" secret, even from patients who may later be liable to pay these prices if they have no health insurer who can negotiate discounts. We also had posted about how medical schools and academic medical centers are often willing to negotiate research contracts with sponsors whose provisions are kept confidential, perhaps to hide provisions that give the corporate sponsor, not the ostensibly academic investigators control of most aspects of the research.
There are some instances in which secrecy in health care is justifiable. Keeping patients' personal data confidential is a a core value for most physicians. It also seems reasonable for companies that manufacture products used in health care to be able to maintain trade secrets about their manufacturing processes.
However, for the most part, we should cultivate transparency and openness in health care. It is hard to conceive of legitimate reasons to keep hospitals' prices, contracts between medical schools and research sponsors, and contracts between doctors and managed care organizations secret. On the other hand, it is easy to think of how such secrecy could hide unethical business practices, and potentially even abuse of patients and corruption.
It is time to end this secrecy.

1 comment:

Anonymous said...

I agree with you about fresh air and openness being a good thing, but in criticizing "secret" contracts between the pharmaceutical industry and institutions, there is a danger of missing something bigger. A huge part of the clinical research operation in the U.S. nowadays is performed by for-profit private research organizations. They are not affiliated with universities or medical schools, and don't have to use institutional IRBs. They have less negotiating power than do universities, less sophisticated attorneys, and more incentive to sign contracts that give away publication or other rights. Many corporate sponsors already shun doing clinical research in academic institutions because of the increased bureaucracy and scrutiny. Increasing regulation and scrutiny of institutional connections with the pharmaceutical industry could have a net negative effect if what it does is drive even more research out of the institutional arena and into these for-profit, much less regulated private research organizations. Everything you say is true, but the playing field must be level. Why continue to pick on institutions when considerably worse things go on in the largely unregulated world of the for-profit clinical research organizations?