Sunday, July 13, 2008
Payola and Doctors
I wrote about the cozy relationship between pharmaceutical companies and academics last month but now the subject is heating up in the New York Times.
Here's how it works. Drug and device makers (think: joint replacements, pacemakers, heart stents) pay doctors and academic programs millions of dollars to collaborate in research, write scientific articles that always show the drug or device to be better, and go on speaking tours around the world, convincing doctors to use the product.
Conflict of interest? Of course it is. The defenders will say that they always "disclose" the conflicts. But here is what they mean by "rigorous disclosure policies and federal guidelines".
The speaker or writer simply reports they are a speaker for a certain company: "I have been a consultant for Pfizer, Lilly and Astra-Zenica." End of story. Every educational program I attend has this disclaimer and every speaker has some type of relationship or another. It's like the do not remove tag on your mattress or the small print in a TV ad. It is so ubiquitous, no one cares.
We don't get told what Senator Grassley, who is investigating these relationships, found out. That Dr Alan Schatzberg, the president elect of the American Psychiatric Association, holds $4.8 million stock in a drug development company that he is promoting. That many physicians handsomely supplement their income with speaker fees and these physicians prescribe three times as many prescriptions of the new powerful drugs to children.
Dr. Melissa DelBello, of the University of Cincinnati, received $238,000 to promote the antipsychotic, Seroquel. Dr. Thomas Spencer, Harvard professor, reported earning at least $1 million after being pressed by Mr. Grassley's investigators. The list goes on and on and we all know that this is just the tip of the iceberg.
I saw a multi page report that showed the names and fees paid to orthopedic physicians to research and speak about replacement joints. This multi billion dollar industry can throw a few hundred thousand at each influential orthopedic surgeon and hire a ready made sales force. Hundreds of surgeons from large and small hospitals across the U.S. have been part of this payola. Many were influential surgeons I know.
There are many who defend this corruption and say it is a way to bring "needed drugs to the marketplace." Who better to test and analyze expensive devices than the doctors? What is wrong with paying doctors for their consulting expertise?
When this much money changes hands, when we see that it does affect prescribing and when so much of it is hidden and under the table, it is hard to make a case that it is ethical. The doctors and institutions on the receiving end will scream loud and hard that they have the "interests of patients" in mind. Don't believe it.
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