Dollar and the medics
| 22 October, 2010 | Richard P. Grant |
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After this morning’s post on the lack of full disclosure of financial interests I quite coincidentally came across this intriguing list of health providers who earned more than US$100,000 from pharma last year.
There are some interesting questions surrounding this sort of list. For example, should the amount a practitioner can receive be capped? Should Europe and the UK have similar open accountability?
[pullquote]Is it a conflict of interest to for a healthcare provider to accept money from a pharma company?[/pullquote]
But for now, let’s go with a simple one:
[poll id=”2″]
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Perhaps, it would be relevant to ask whether the MDs were doing work for the companies in the pharmaceutical industry. If they were actually working on a study or screening patients for inclusion in a clinical trial. However, $100,000 seems to be a lot to pay someone who also has a practice. Should there be limits? It seems difficult to determine what such a limit should be, and the real problems arise when such a cozy financial relationship threatens the well-being of the patients.
This is a monstrously sleazy way of doing business, one which can’t help but spawn dishonest research heuristics, dangerous medical practices, and harm to patients.
As a clinician I have found many of these “Drug Talks” to be very important sources of clinical information. Especially after the formal talk, one gets to meet and speak with recognized clinicians and “pick their brains” and exchange ideas. This, while someone “picks up the tab.” Most of us are smart enough to tell when the speaker is only there to “sell the product.”
As a paid lecturer, I believe that it is more important to maintain my credibility then to sell a product for anyone, no matter how much they pay me.
Physicians who “sell the product” without any objectivity quickly loose any appeal as a speaker. Physicians are usually smart enough to pick up on the difference.
The one area of concern is when physicians are paid to speak to the lay public. While these types of forms are sometimes useful to convey information about a disease, they are ripe for abuse. Many of my patients may come to me after attending such a lecture asking about a drug which is not right for them.
There should be some type of reasonable control system in place, probably along with some type of a cap. This would/should be done across borders as well.
The NPR article points out that the reason that they pay most of the doctors is not to get them to spread the word, but to get thenm to prescribe even more of the product. the deliberately pick those physicians who are at the top in prescribing their product. Big Pharma has found out that by letting these physicians become “thought leaders” (even if they never had an original thought they are flattered by that moniker) that those doctors boosted their sales by six figures in a month by prescribing even more of the medication. Any physician that the thought leader talked to ( the money was usually for a dinner talk at Applebee’s) who also increased prescribing was a bonus. An investment of $1500 pays off by several orders of magnitude.
The really big bucks go to the true thought leaders, the academics. One friend of mine (who is critical of the whole idea of paying doctors, by the way) got over $50,000 from one company. Most physicians who take the money don’t realize they are being played.
Yes it’s a conflict of interest as it raises the possibility that drugs from a certain company are being prescribed to honor some kind of contract, when they ought to be prescribed because they are in the patient’s best interests.
I think the issue is not that black and white. Despite what many people think, physicians tend to be a very ethical group of individuals, and there are many intelligent well meaning people who speak for the pharmaceutical companies for a variety of reasons. I recently began speaking for a couple of companies who produce medications that I think have some advantages over their competitors based on my clinic experience and review of the data. I would never feel comfortable speaking about a product that I would not want to use myself. I had never been a speaker before but realized that I enjoyed public speaking and wanted to give it a try. I won’t deny that there is a financial reward but I have really had a good time speaking to and with my colleagues. I feel that I have 20 years of experience to share and that I can learn somethings myself. The educational experience often supercedes the promotional character of the events. I know there are bad apples in every area but I don’t think a blanket ban would be wise. Physicians aren’t stupid and they generally know when they are being fed a bill of goods.