Dr. Grouse was involved for many years trying to raise money from the pharmaceutical industry to assist in various enterprises on behalf of both NIH and WHO. This vantage point brought him into contact with many leaders of MPOs and he relies on that experience in his commentary.
Dr. Grouse has several things to, well, grouse about. He shares my own personal views on the predominance of US physicians in specialty practice vs. generalist or primary care and the distorting influence that has on health policy and on driving up costs. He also would obviously like to see major reforms in how health care is financed in the US in the direction of universal access, greater attention to public health, and prevention. As this blog is focused on one set of issues only I shall pass over that portion of his commentary and stick with the drug industry.
Dr. Grouse makes the following interesting points:
- On attending the typical MPO meeting: "The practicing physician members of the MPO were off in the convention centers attending scientific lectures that would expand the medicines, procedures and costs of their practices and wandering through the exhibit halls collecting free presents and drug promotion at the Pharma booths, whereas the specialty society leaders were meeting in plush Pharma hospitaliy suites to trade the loyalty of their members for Pharma money."
- "An undisclosed way of funneling Pharma money to MPOs in Europe and Asia is the common practice of Pharma paying for specialists to attend their MPO's annual meeting. ...A leading physician marketer from an international company recently told me he estimates that 80% of the attendees are funded in some way by Pharma at many MPO meetings. In the United States, Pharma no longer pays physicians to attend CME conferences; however, it is unknown how many physicians from outside the United States are paid to attend, and the percentage of non-US attendees at medical conferences has grown greatly over the past 2 decades."
- "It goes without saying that most of the talks listed on the [typical cardiology CME] program are about the use of pills, devices, and procedures to diagnose and treat heart disease. It is almost as if the MPO was employed by Pharma to encourage physicians to prescribe pills, devices, and procedures. Preventing illness, providing fair and universal care, and caring about the patient do not appear in the program." [Dr. Grouse uses "Pharma" to include device and equipment makers as well as drug companies.]
- Dr. Grouse also argues that the scientific peer review system has become corrupt as so many of the highest-reputation members of study sections, journal reviewers, etc. are "key opinion leaders" who are being paid large sums as speakers and consultants by "Pharma."
- "I often wondered whether he MPOs that advocated the use of the medical model involving expensive and high-tech care were improving public health or whether they were diverting resources from population-based approaches and simply enriching their organizations and member physicians at the expense of public health."
Dr. Grouse ends with a long list of needed reforms, which, as you would expect, are all along the lines of what in HOOKED is called the "divestment strategy" of medicine disengaging from virtually any financial ties to the drug industry.