Conflicts of interests in medical information…

From the drug rep of the huge pharmaceutical company promoting a new anti-arrhythmic drug:

 “Dr Mandrola, you are a leader in the area so we would like you to be on our speakers bureau.  Of course, you are reimbursed for your time”

“Really?”  Maybe they know about my blog, I wonder.
“Sure, we can send you to New York for our speakers training.”
“Well, I have my own slides on AF, and I’m an adequate speaker so you can save the cost of educating me,”  I add with EP-like arrogance.
“Oh, …well, …its mandatory, and you have to use our slides.”
Needless to say, membership on their speakers bureau had far too many strings for me.
I take no income from any medical industry.  Zero, not even pens anymore.   This absence of financial ties feels great, like a puffer when your wheezing. Lack of conflicts provide an opportunity to speak freely, not even the sub-conscious is affected.  As I grow older, more experienced and even a shade wiser, company logos in the margin of websites, or on the headers of emails seem so obvious.

Now, not all that is sponsored by medical device or drug companies is corrupt. Far form it.  Leaders in industry, like JNJ, Medtronic, Boston Scientific, Pfizer and many others have enhanced our ability to doctor, and in doing so have enhanced the lives of patients.  Good on them.  But they are for profit entities with boards of directors, and shareholders who expect profits.  Employing opinion leaders who nearly always reside in the cocoon of academics influence doctors who prescribe their products.  I think this is called marketing.

Beware, you seekers of knowledge on the vast frontier of the internet.

JMM

3 comments

  1. john- so as an employee of the medical industry Im probably a little biased but not in the direction you may assume.

    There are many, many illicit relationships btw industry and md's, some of whom you are familiar. Thats why the drug rep cant let you use your own slides. As part of self-governance and to be compliant to the rules we've all (sorta) sworn to abide by, a set of slides cleared by legal to be on-label, appropriate, factually correct and representative of the product can be the only option. Any deviation from this rule puts both you and the company in jeapordy.

    Now, does this mean that using a key opinion leader board as an enticement is appropriate? Of course not. If there is implied benefit to either side of a business nature then the relationship is illegal. If, due to your experience, which is well known, there is benefit of a non-business nature then the relationship can be viewed as appropriate but must be handled very carefully. Thre's a lot of wrong doing from both sides occurring nationally, but you and I both know that its better than it was 10-15 years ago. I feel better about the business now than I did in 94 when I started. This little diatribe isnt to say that you made the wrong decision by backing away, you trust your instict, you have to. Im always interested in how it looks from the other side. slippery slopes abound here, but they exist on both sides.

  2. B,

    I hear you, and thanks for the well thought out words.

    Drug company influence is slightly more transparent these days. This is a good thing.

    Maybe it has always been the case, but it seems as incomes of the academic doctor go south, their disclosures go up. So many financial relationships have to affect opinion.

    I found out about this phenomenon early in my blogging days, when I bashed the high fructose corn syrup containing Gatorade. Moments after posting, an email came, reminding me of the fact that Gatorade is a team sponsor. Oops. So I thought this stuff is bad for you, but in the interest of self-preservation, I stopped bashing it.

    It is true that the professor's words serve to influence medical practice, but with all these conflicts, how can we be sure of his/her real opinion?

    I reiterate that, not all one says is discredited by a business relationship, only that the reader should know of these possible influences. Herein lay the beauty of us doctors without industry ties.

    Although, a far-away reader has no idea who I am, or whether I know anything, they can know that my opinion is not affected by any ties to industry.

    JMM

  3. JM2- i guess the ultimate evidence of this is that the most impactful cliical trials are the ones not paid for by industry. I agree, never trust someone that I paid to tell you that Im right.
    bs

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