HIGPA – Eternal Sunshine of the Spotless Mind

By Curtis Rooney

Remember the movie “Eternal Sunshine of the Spotless Mind?” It starred Jim Carrey, Kate Winslet, Kirsten Dunst and Elijah Wood. The plot was your basic boy meets girl, boy loses girl, boy gets girl … but a lot weirder. Washington is said to be Hollywood for ugly people. Maybe that is why Senators Grassley (R-Iowa) and Herb Kohl (D-Wisc.) have introduced the Physician Payments Sunshine Act of 2007 (S. 2029), a bill with a similar name and, perhaps, ending.

In the movie, Clementine (Kate Winslet) and Joel (Jim Carrey) are boyfriend and girlfriend. They fight. She decides to have her memories of their relationship erased from her mind by Lacuna Corp. Joel, of course, is devastated. He goes to the doctor to have the same procedure done to erase his memories of her. In a twist of fate (and while unconscious) Joel reconsiders and decides he wants to keep his memories of Clementine. Later, although they do not realize it at the time, they are former lovers now separated after two years together.

At the same time, the employees of Lacuna are revealed to be more than peripheral characters in scenes that further show the harm caused by memory-altering. Mary (Kirsten Dunst) has had an affair with the married doctor, Dr. Howard Mierzwiak, who heads the company (Tom Wilkinson). She agreed to have the affair erased from her memory when his wife discovered the relationship.

Once Mary learns of the affair she has had with the doctor, she steals the company’s records and sends them to all of its clients. Thus Joel and Clementine both get to listen to their initial tape recordings at Lacuna, learning that they were former lovers. As a result they realize that even if everything in life isn’t perfect, their relationship can still be worthwhile.

I doubt Senators Grassley and Kohl thought of all this when they introduced their bill. Despite the obvious differences, the message is surprisingly similar. Under the bill, payments to physicians or their employers made by manufacturers of drugs, devices or medical supplies under Medicare or Medicaid would be required to be reported quarterly to the Secretary of Health and Human Services. Note: the Health Industry Group

Purchasing Association and many others support this legislation. HIGPA believes that the public is best served if it is allowed to judge for itself whether these relationships create an actual or perceived conflict of interest. As you’ll see below, a more transparent healthcare supply chain is good for everyone and probably a lot less painful than more strident regulation and certainly mind erasure.

Because truth is often stranger than fiction, assume for a moment that Mary, rather than Dr. Mierzwiak, owns Lacuna Corp. Also assume that Tom Wilkinson is, well, Dr. Mierzwiak, and would therefore be covered under the legislation. Mary, on behalf of Lacuna, the maker of a medical device (we’ll also assume that erasing minds is FDA approved), would need to report any gifts she may have bestowed upon Dr. Mierzwiak in the course of their “business.” The actual bill is a little wordier and talks about “the nature of the payment or other transfer of value” but the idea is the same. Unfortunately for Mary, these gifts would be placed on a public Web site for all to see — including Dr. Mierzwiak’s wife.

Most agree that pharmaceutical and drug device companies benefit patients by working with physicians in the process of innovation and improvement. While it would be better for everyone if these firms (and physicians, for that matter) were spotless when we need them to do what they do, that’s not always the case. The moral of the story is clear: If you go to bed in the wrong place, you risk getting fleas. And just like Clementine and Joel (and senators Grassley and Kohl), we may all wake up afterwards to realize that even if everything in life isn’t perfect, many of these relationships can still be worthwhile.

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