MESSAGE
| DATE | 2005-08-02 |
| FROM | Ruben Safir
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| SUBJECT | Subject: [NYLXS - HANGOUT] Its never too late for a good scam
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JEROME P. KASSIRER
Doctors and drug companies
By Jerome P. Kassirer | July 6, 2005
DRUG COMPANIES spend billions of dollars each year on educational
programs for doctors in the form of ''unrestricted educational grants."
The companies swear that in supporting physicians' meals, meetings, and
events, all they care about is educating doctors, but the US Senate is
now asking how much of the content of these programs is education and
how much is product marketing.
Given the impending expansion of prescription drugs through Medicare,
it's certainly appropriate for the government to be worrying. In their
recent letter, the Senate Finance Committee asked 23 major drug
companies to provide extensive data on these grants, including their
purposes, total expenditures, and the identity of the recipients.
Cautioning about ''potential for abuse," the letter expressed concerns
that industry-sponsored programs might increase cost ''and may encourage
the use of typically newer, more expensive drugs." For emphasis, the
committee gave them only weeks to respond.
The ultimate recipients of these funds, namely hospitals, medical
centers, medical schools, professional medical organizations, and
individual physicians, should also worry about the disclosures. Except
for a handful of people, nobody has raised questions about whether
''unrestricted" grants are truly unencumbered; whether there are hidden
incentives for some kind of ''payback." Nobody has inquired how
recipient organizations arrange to get the grants, how much they
receive, or how they administer the grants. Congress has finally opened
the Pandora's box of industry sponsorship of continuing medical
education, and once it discovers where the money is going, it seems
likely that they will come calling, not just on the grantors, but also
on the recipients.
Why does medicine have a problem? Because industry pays for well over
half of the expense of doctors' continuing medical education. Virtually
all the continuing education departments in hospitals, medical centers,
and medical schools rely on drug-company funding. Everybody does it, and
when four drug companies gave the Massachusetts General Hospital's
Psychiatry Department $6.5 million dollars to spread its educational
expertise, the reaction was muted.
Professional societies are equally dependent on drug-company money. They
rely on grants for operating expenses, for running enormous annual
meetings, and for developing treatment recommendations for practicing
doctors. Societies solicit funds by peddling chunks of their annual
meetings. For sale: company tote bags, a rodeo, a barbecue, or a
cocktail party.
Drug companies also pay individual doctors to speak at national
meetings, medical center conferences, and restaurant back rooms. A
Boston physician lectures in a fine restaurant within walking distance
of Yale Medical School; a top physician joins 200 others in a
drug-company sponsored seminar about a single drug, with the promise
that he will become a company-paid speaker.
The concern is hidden bias. Do directors of educational programs
intentionally choose company-sponsored physicians to give the talks? Do
they allow conflicted speakers to hawk drugs for purposes not approved
by the FDA?
Some medical societies have been suspected of bias because their medical
practice recommendations were formulated by physicians being paid for
speaking or consulting by companies that could gain from slanted
recommendations. The medical societies argue that industry-paid experts
can dominate in such deliberations and that disclosing all financial
connections magically avoids bias.
Unfortunately, these disclosures do not tell a doctor whether such
recommendations (that they use in everyday practice) are balanced. And
how can we expect company-paid speakers to be objective when their talks
are regularly observed by company representatives? Many financially
conflicted speakers undoubtedly bend over backwards to be even handed,
but they won't last long on the circuit unless they speak favorably
about their sponsor's products.
Should physicians take gifts, meals, and speaking honoraria from
industry when reporters do not? Isn't the veracity of medical
information as critical as civic or political news? It makes no sense
that financially conflicted physicians should be developing educational
materials and practice guidelines. Many organizations and individuals
are likely to be embarrassed by Congress's disclosures, and medicine
risks having its reputation sullied further. Practicing doctors need to
trust the recommendations of academic physicians and their professional
societies, and people need to be able to trust their doctors.
Medicine must begin to extract itself from the open arms of the drug
industry. In turn, the pharmaceutical companies, by engaging so many
physicians and organizations in its marketing ventures, is doing a
disservice to the very profession that it relies on to analyze,
recommend, and prescribe its products. Industry too must back off.
Extracting medicine from industry's educational ventures will be
painful, but probably less painful than inappropriate and more costly
medical care or the opprobrium of a disenchanted public.
Dr. Jerome P. Kassirer, a professor at Tufts University School of
Medicine, is author of ''On The Take: How Medicine's Complicity With Big
Business Can Endanger Your Health."
© Copyright 2005 The New York Times Company
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