So--for the past few years some of us have been hammering away at why it is ethically bad news for docs to take cash from drug companies for activities such as speakers' bureaus. How are we doing? A longish report by Kris Mamula in the Pittsburgh Business Times:
--provides us with some clues.
First, Mamula is able to report payments to docs in the Pittsburgh area made by four large drug companies that either voluntarily released data or are doing so under legal pressure from litigation. It's noted that 8 other large drug firms currently have no such disclosure. The article as a whole in my view is reasonably balanced but with a slight tilt against the practice of commercially-paid speakers.
What seems to give us a clue as to the current situation is some of the comments from docs, handing out the same tired rationalizations we have been hearing for decades. Dr. Anthony Gentile, an ob-gyn and top pocketer of company funds ($89K) in the Pittsburgh area, said: ...the notion that drug companies could influence doctors’ prescribing practices [is] “total, unequivocal hogwash.” “People think we get up there to push this drug or that drug,” Gentile said. “That’s not what we do. We just say this is something you should consider. We educate, and that’s what I have a big passion for.”
From Dr. Lawrence Glad, a Uniontown-area gynecologist who came in at third-highest-paid at $74,916: “Yes, it’s promotional, but it’s educational...I think we have some critical skills for our patients beyond who bought my last bagel.”
Glad made presentations in small towns, including Parkersburg, W.Va., where doctors have few opportunities to learn about the latest developments in medicine. These aren’t people “who can walk down the hall and hear nationally known doctors,” he said. “These are people who are lucky if they can get to one conference a year.” At least Dr. Glad was willing to admit that it's both promotional and educational--that's a step ahead of the old bromide, "it's not marketing, it's education."
Said Dr. Michelle Roberts, an endocrinologist and faculty member at the University of Pittsburgh School of Medicine: she takes her teaching role seriously at drug company sponsored sessions and always receives approval from her supervisors. Last year, Roberts received $8,525 to discuss the Lilly drug Forteo, used to treat people with severe osteoporosis.
Her purpose during the session was teaching, not selling, she said.
“I’m an educator, and my role is to better educate physicians about how to care for women with osteoporosis,” she said. “I would not compromise my job or integrity to sell drugs for Eli Lilly. I’m not a puppet for the drug companies.”
Psychiatrist and Allegheny County Medical Society President Dr. John Delaney, who received $69,350 from Lilly last year, said the money he receives from Lilly doesn’t affect his prescribing practices.
“The transparency has made it look like a bad thing, but I’m not embarrassed about it. I’m a big speaker for them....You end up prescribing the best drug at the time, regardless of the affiliations you have. I think all of us feel that way.”
Unfortunately, if these local docs seem to be in denial about the likelihood that their taking company money might influence their own prescribing or the message that they "educate" about, the official policies adopted by the local medical centers seem to compound the problem. For example, the University of Pittsburgh Medical Center's conflict of interest policy says: faculty members “may participate as speakers, provided that they prepare their own content without any control or approval of the content by industry.” What the policy ignores is that any faculty who actually follow this advice are likely to be in serious hot water with the Feds. If you take money from the company, you're considered a company employee, and are bound by the same rules for what you can and cannot say in marketing a drug--especially about off label uses--as is the company as a whole. Get off message and you're likely to find yourself facing Federal criminal charges. So the idea you have have your cake and eat it too--take the money but also maintain your independence as an academic physician--is sadly mythical.
The better advice comes at the very end of the article: For many years, Dr. John Walsh, distinguished service professor of urology at Johns Hopkins Medical Institutions and a critic of some drug company funding to physicians, said he has long told students, “You can have your money or you can have your reputation, but you can’t have both.” If the remainder of the article is any indication, many docs in Pittsburgh have not yet gotten the message; and their likelihood of having gotten the message seems inversely proportional to the amount of money accepted from drug firms.