Tuesday, February 19, 2013

More from ACRE: It's Us, or Those Evil Insurers

I'm grateful to my colleague Dr. Roy Poses from Health Care Renewal for this link:
(You have to register to enter the site but it's free.)

Medscape features an interview conducted by Dr. Henry R. Black, an internist and clinical professor at NYU, with his colleague Dr. Michael A. Weber of SUNY Downstate/Brooklyn. Dr. Weber is one of the mainstays of ACRE, whose new guidelines on relationships between industry and medicine we recently reviewed: http://brodyhooked.blogspot.com/2012/11/roses-and-thorns-by-any-other-name.html

The ostensible purpose of the brief interview (you can watch the video or read the transcript) is to introduce you to these guidelines, which as I already noted are not all that bad. Mixed in with this announcement, however, is something of a new rationale for why we should ignore conflict-of-interest concerns and applaud physicians' financial ties with the drig industry as part of continuing medical education.

Dr. Weber, in common with the rest of the ACRE leadership, cannot fathom why people like me (a.k.a.pharmascolds) are not wildly impressed with the fantastic, lifesaving and lifeprolonging medicines produced through private enterprise and the entrepreneurial spirit--they see only the upside and never the downside of these developments. As Dr. Weber paints the picture, docs have two chioices when it comes to CME. Either they can embrace folks like him who freely take money from drug and decvice companies, who of course will tell you completely objective information about these marvelous life-saving new products, that you'll then use to dramatically improve your patients' health.

The other alternative is to let other people run CME, and according to Dr. Weber, this would inevitably be insurance companies who want to save a buck and don't care whether or not patients die as a result of their skinflint practices. They'd make sure that the CME program contained little if any information about these marvelous new drugs, for fear docs might prescribe them and run up the tab. 

So let's see if I get this--conflict of interest is wonderful when practiced by industry CME sponsors and their physician partners, because it means that we'll more speedily adopt more life-saving medicines. On the other hand, conflict of interest is terrible when practiced by third party payers, because all they want to do is save money and they don't care if patients are harmed. This of course assumes that patients are always harmed by using an older or cheaper drug, or no drug at all, and are never harmed by using the latest brand name, expensive drug. It also assumes that the only reason one could possibly be against conflicts of interest between medicine and the drug industry is a desire to cut costs--that it has nothing to do with quality of care or the integrity of the scientific process. Or that thing called "professionalism" which ACRE folks have said does not exist.

Dr. Poses is a sort of expert on argumentative fallacies so I'll let him decide which category of fallacy this argument falls under.


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