Friday, March 13, 2009

Big Pharma and Doctors

It is insane that we let problems get out of hand and then OVER-REACT by legislating ridiculous rules that hurt industry and growth. I am speaking about the new federal law that Congress is discussing that says medical device and pharmaceutical companies cannot give pens or lunch or sticky note pads to physicians and they have to report any consulting or speaking payments of over $50.00. Massachusetts has already adopted these bans and there is a patchwork of other states with their own laws.

I have written before about the egregious behavior of physicians and research institutes being far to cozy with big Pharma and Medical Device manufacturers. Orthopedic surgeons have received hundreds of thousands of dollars (each) in "consulting fees" for using certain expensive artificial joints. The American Academy of Psychiatry is cleaning house after being exposed by Senator Grassley's investigation into the unethical behavior and unregulated greed of academic psychiatrists promoting questionable drugs for kids. I've also written on big Pharma price gouging and how it should be stopped.

So make no mistake...I am against corruption, lack of medical ethics and greed. We are here for the good of our patients...period.

That said, the pendulum is swinging too far. Innovation is the hallmark of advancing medicine. There is a natural affinity for research physicians and big Pharma and it is usually a healthy relationship. Clinicians are dependent upon continuing education throughout their careers (or we would still be using lobotomy or arsenic to treat infection) and much good comes from programs that advance our knowledge. Those programs need credible speakers and those speakers need to be well compensated for their expertise.

I have been a pharmaceutical speaker and I was well compensated. My talks were balanced with evidence based literature, treatment options and outcomes. I was sponsored by Lilly, Wyeth and Pfizer at different times. If I had to fill out reams of paperwork or be offered $50, they would not have secured my service (or anyone else that could hold the attention of a crowd)

The legislatures that are adopting these laws need to look in the mirror and clean up their own house first.


Steven Reidbord MD said...

Sorry, I disagree. The proposed legislation only requires documenting speaker fees; not "reams of paperwork." There would still be no limit on the fee itself. As you know, congressional inquiry recently found several prominent speakers (in my field, psychiatry), who lied about receiving fees to speak on behalf of drug companies. Other areas of medicine will be next. Having a paper trail seems like the minimum to assure unbiased physician education.

There are good blogs on the corrosive effects of Big Pharma on CME (continuing medical education). See:
Carlat Psychiatry Blog
My own blog
and many others. Marcia Angell, former editor of the New England Journal of Medicine, argues that industry should not pay for physician education at all, as the risk of bias is too high. While no one claims all industry-sponsored talks are biased, and Dr. Angell's position is an extreme one, there's an inherent conflict of interest that must at minimum be monitored closely.

The restrictions on pens, lunch, and sticky-notes were voluntarily self-imposed by PhRMA, the drug company lobbying group, as of Jan 1st this year. Personally, I think that was a good idea too.

Quiact said...

Our government is proposing such insignificant rules to pacify the public so they will remain ignorant of really what occurs within a large pharmaceutical company.

Each sales representative, the grunts of the industry, on average, spends about 50 grand a year on promotional activities. Do the math. That is 5 million dollars right there.

Add in other variables, such as samples, 200,000 per pharmaceutical sales representative (with company car and incredible benefits), and it's billions spent on marketing. Much more than R&D. How often is this shared with the public?

Toni Brayer MD said...

Dr. Steven and Quiact: I agree with you about the abuses and rampant unethical behaviour. That said, focusing on pens and sticky notes just distracts us from the real kickbacks that are occuring within the medical device industry.

It is the over regulation and misplaced focus that I object to. On the one had congress is outraged at token gifts but legislates "no bargaining" for drugs under Medicare Part D. The US pays many times more for the same drugs as other countries because they are in bed with Big Pharma too.

Craig said...

I don't know about you but I miss the trips and dinners big pharma would host with grand style. Back in the day; when I dated a few Doctors, I'd get to go along as the doc's guest to those events. As a layman, I learned a lot about medicine listening to the lectures and Q&A My dates would consistently tell me that they were so swamped with patient care and managed care paper work that those events were a good way for them to keep up with drug efficacy and have good dialog with their peers about patient care. Although I never dated a psychiatrist, I don't think the sampling of doctors I did date prescribed any more or less just because a company hosted them at a dinner or a weekend in Palm Springs. Now putting a doctor on the payroll that is a different issue.

Steven Reidbord MD said...

Toni: I agree that focusing on pens and sticky-notes distracts us from larger injustices (like the no-bargaining provision of Medicare Part D, which is an outrage). Still, even little, or symbolic, gestures have some meaning. Since physicians are dedicated to offering unbiased advice, we ought to actively avoid commercial influence, or even the appearance of influence.

Craig: I'm sure the industry trips and dinners were nice. And as a non-doctor, you had no conflict of interest, so I hope you enjoyed yourself. Unfortunately, several research studies show that doctors' prescribing patterns do change as a result of sponsored trips and dinners. The companies aren't spending billions for nothing, even if everyone feels it's "the other guy" who is influenced.

Craig said...

I agree and if more people in all industries had your integrity we wouldn't need any of these checks and balances. I happen to think Nancy Snyderman is very smart and a competent doctor. She is also extremely good TV talent as a media doc delivering information to the public. But look at her slip up in 2002. December of 2002

"Dr. Nancy Snyderman, a journalist penalized by ABC earlier this year for endorsing Tylenol in a radio commercial, is leaving the network - to work for the same company that makes the pain-killer.
Snyderman is leaving her gig as a medical correspondent to become vice president of medical affairs for corporate giant Johnson & Johnson.

There, Snyderman will advise the company and its affiliates on the introduction of technologies.

In April, Snyderman was suspended for a week without pay after the Daily News revealed she had done voice work for a radio commercial touting Tylenol.

Doing so violated ABC News policy against employees endorsing products or performing in commercials.

She publicly admitted the Tylenol spots were a mistake."

today 2009 Snyderman is at NBC