Physicians and the Prescription Drug Industry
Health and pharmaceutical experts testified about the financial relationship between the pharmaceutical industry and physicians. Topics… read more
Jerome P. Kassirer M.D.
On the C-SPAN Networks:
Jerome P. Kassirer M.D. was an Editor-in-Chief for the New England Journal of Medicine with three videos in the C-SPAN Video Library; the first appearance was a 1997 Call-In. The year with the highest average number of views per program was 2007 with an average of 311 views per program.
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Previously
Editor-in-Chief, [New England Journal of Medicine]c. December 31, 1991 - c. September 1, 1999Videos: 3RECENT APPEARANCES
Physicians and the Prescription Drug Industry
Health and pharmaceutical experts testified about the financial relationship between the pharmaceutical industry and…
Future of Private Practice
Panelists talked about the state of managed care in the US, Medicare reform, and the future of private care doctors in the…
New England Journal of Medicine
Mr. Kassirer talked about the role of the magazine in the medical community and took audience calls, faxes and electronic…
APPEARANCE STATS
2007Videos: 1See all videos
1999Videos: 1See all videos
1997Videos: 1See all videos
- Journal List
- Mo Med
- v.108(5); Sep-Oct 2011
- PMC6188385
Money for Drugs
YES
If physicians cannot ethically be paid to develop and test new drugs, then who is to carry out this vital work? Non-physicians? Employees of drug companies? Congress and the media?
NO
Physicians should not receive even fully disclosed money from drug companies and medical device makers for research, consultation, royalties, lectures or CME efforts.
Five authors weigh the options.
YES
The Cause of the Day for many pundits and academics is the terrible wrongness of physicians’ taking any sort of payment from pharmaceutical companies. Drug companies – otherwise known as Big Pharma - have been demonized by the media, academia, and politicians. They make too much money; charge too much; market too aggressively. We’ve all heard the litany of complaints. But, are they really evil? Are we really wrong to interact with them?
We are having a national discussion over the propriety of physician relationships with industry. The tone of that discussion is hostile to both physicians and industry. The discussion is being largely conducted within medical journals which themselves are partly supported by drug company advertising, and reported by news media which also profit from commercial advertising. Two of the most popular books on the subject were written by former editors of a journal that accepts drug advertising, and charges a lot for it.1, 2 Should we have different ethical standards for medical journals than we do for individuals? Perhaps so. But that argument is not being made. There is a whiff of hypocrisy about the whole discussion.
It would be well to define some common assumptions. First, physicians can - and should - be paid for their time. The ethical position that physicians should work for nothing may be valid, but it pretty much closes off this discussion. Secondly, it is unethical for physicians to sell their opinions to the highest bidder. We should not go out and urge other physicians to use a given product simply because we are paid to do so.
This is, contrary to what many believe, a complex issue. To begin with, is it ethical to work on drug development and clinical investigation? Most of us would say it is. How can it be otherwise? If physicians cannot ethically be paid to develop and test new drugs, then who is to carry out this vital work? Non-physicians? Employees of the drug companies? Congress and the media?
Suppose a physician serves on an advisory panel for, let us say, the development of a new cardiac drug. That involves time and travel, perhaps other expenses. If physicians cannot participate, I ask again: Who is going to do it? It is in society’s interest that the best clinicians advise the companies. Can it seriously be claimed that the companies should develop drugs without input from physician clinicians?
Most drug studies are funded by contracts with institutions, although some are with individual physicians or groups. Does it make an ethical difference whether the money goes directly to a physician or indirectly through the salary from a university? Surely not. Otherwise, anything could be justified by simply laundering the money through some convenient institution. One may argue that certain institutions, like universities and hospitals, have such high ethical standards that it is inconceivable that they are influenced by mere money. One may argue that, but one is unlikely to be believed.
Consider a quotation from Dr. Gordon Gee, the President of Ohio State University. Now, Time magazine named Dr. Gee as the best college president in the country in 2009, so he must be pretty well up in the profession. Recently, Ohio State football coach Jim Tressel was caught in a particularly flagrant alleged violation of the NCAA rules. When asked whether he would fire the coach, he responded, “No. Are you kidding? I’m just hoping the coach doesn’t dismiss me.”3 Perhaps he was making a joke. A medical school dean once told me, many years ago, “Charlie, there is no such thing as dirty money.” In short, as much as universities would like to believe otherwise, there is little justification for handing the ethical decision-making to them.
Perhaps the most troubling facet of this issue is represented by speakers’ bureaus. We all benefit from experts traveling about the country and teaching the rest of us. Most frequently, that teaching is at medical meetings, but it also occurs at universities or in hospitals. Funding comes from a variety of sources. Leading universities fund such activities out of their endowments, but other universities and most hospitals find the money where they can. Frequently, the money comes from the pharmaceutical industry, directly or indirectly. Medical societies receive dues from members, but also grants from drug companies. For some, it may feel good to say that no such money should ever be accepted. But we would be the poorer if these activities were to be curtailed. Indeed, we regard it as virtuous that physicians seek out continuing medical education, and our licensing agencies even require it.
We should realize that some physicians are abusing the system. We have a few colleagues going around the country making hundreds of thousands a year advocating this or that particular treatment. Many others don’t make as much money, but are nevertheless shills for one company or another. Sure, they probably believe in the treatment they are promoting. They may use it themselves. But if you were in their audiences, knowing how much they were paid would influence how much credibility they might be accorded.
We need more transparency. Put the information out there, and let everyone see. A number of states – Minnesota, Maine, others - have enacted reporting laws. Several companies, including Pfizer, Merck, Eli Lilly, and GlaxoSmithKline, report their financial transactions with physicians.4 There is also a public database that reports such monies.5
The Health Care Reform law – the Patient Protection and Affordable Care Act – mandates a national database. Specifically, drug and device companies must report all payments to doctors and teaching hospitals. Companies must post the information. The Department of Health and Human Services will also post data, beginning in 2013, and there are serious fines for failure to report.5
Our profession exists in symbiosis with the pharmaceutical industry. It is in society’s interest for us to work with drug companies to ensure that they develop the drugs we and our patients need. But we are not their apologists. It is strongly in our interest to see that we and they behave in an ethical manner. If that causes us distress and soul-searching over the next few years, so much the better. Make no mistake. There have been problems, and they are our collective responsibility. We should not tolerate the “bad apples” in our midst. We should assist in efforts to make the process as transparent as possible. Moreover, we should educate policymakers and the public on the complexities of our interaction with those who produce the drugs and devices on which we all depend.
Let us not be seduced by the arguments of people who are not our friends. We cannot practice medicine without pharmaceuticals. But we can practice medicine just fine without politicians or the media. They are not our friends; nor are they unbiased. They have unquestionably hurt the medical profession over the past two decades. Neither the US Senate nor the New York Times can make drugs or develop new ones. Yet they are generating a demand for an unrealistic ethical purity law, prohibiting all paid constructive contact with drug companies. Their arguments are that physicians are greedy, foolish and easily manipulated by drug companies. But there is neither merit nor reality in that specious assertion. Most physicians are actually fairly hard to manipulate. Ask anyone who has to deal with us. Most physicians are ethical. Greed is a characteristic of politicians far more than of physicians. The public trusts physicians much more than they trust journalists.
To counter these arguments, we can advance the principles of autonomy, individual responsibility, and professionalism. These are often brushed aside. Yet it is our professionalism, judgment, and responsibility as physicians that make us of value to our patients. Without these, we become simple health care workers, cogs in the machine. There are certainly problems in our relationships with Big Pharma, and we must repair them. But barring all contact would be a poor answer.
Ultimately, we serve our patients, and through them, society at large. We owe them our best judgment, and we owe them our professionalism. We will not accomplish either by adhering to a mindless prohibition, as appealing as that may appear to the moralist in all of us.
Biography
Charles W. Van Way, III, MD, MSMA member since 1989 and Missouri Medicine Contributing Editor, is a Professor of Surgery and the Sosland/Missouri Endowed Chair of Trauma Services at the University of Missouri - Kansas City.
Contact: ude.ckmu@cyawnav
Footnotes
Disclosures
Dr. Van Way is a member of the Residency Review Committee for Surgery of the ACGME. He receives no compensation for this service.
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