October 13, 2008
Pens and doughnuts
Disclosure: My father and mother were both physicians so I obviously have a pro-doctor bias. Not only that, but my dad sometimes passed on to me the goodies he received from sales reps, and I still have a small case he got for his stethoscope. I use it for a multidirectional microphone that's handy for taping round-table discussions. On its cover it says “Lilly,” proving that I've also been bought by the pharma industry. At least that's what current conflict-of-interest accusations would suggest.
Why else would the Association of American Medical Colleges (AAMC) adopt a policy that calls for a ban on free food, gifts and travel for doctors and students at its 129 member colleges?
Incidentally, the chair of the AAMC task force that drafted this document was Dr. Roy Vagelos, retired CEO of Merck, and how did he keep from being tainted? Or take a recent Journal of the American Medical Association editorial that claimed that “the profession of medicine…has been inundated with profound influence from the pharmaceutical and medical device industries,” and challenged doctors to stop accepting company gifts, while the Massachusetts legislature passed a law to make compliance with the PhRMA marketing code a legal requirement. So much for getting ahead of the curve through voluntary action.
Meanwhile, a similar bill pending in the US Senate draws the line at gifts over $25. Apparently, at least, you can't buy a doctor with a doughnut or a pen.
Am I suggesting that there have never been doctors on the take? My own experience says otherwise.
One time I submitted a transcribed symposium presentation to the author for approval of publication and he called to say he had to see me. He had no objections to our edits he said, but he would not sign off on the draft unless we doubled his honorarium. I pointed out that this would not be fair to the other contributors. So double theirs, too, he said generously. Only when I told him that we would reluctantly have to drop his contribution did he relent. When I mentioned this encounter to one of his California colleagues, he said lightly: “Oh, he's working on his white Rolls-Royce Corniche.”
So, yes, some physicians are corruptible and the evidence suggests that so are some legislators, and for all I know even some columnists. But that raises two questions. The first is whether standards and regulations can ever weed out the crooked and the greedy. The other is more serious, because it can have a deleterious impact on public health. Take the FDA's tightening of its conflict-of-interest regulations, requiring financial disclosures that may well make industry consultants reluctant to serve on its advisory committees—and who knows more about drugs under review than those who have studied them? And what about the current drive to stop all industry-supported CME? The question is no longer whether consultants' advice is honest, knowledgeable and useful, or whether the educational materials are accurate and fair, but whether, to quote the AAMC report, what it calls reciprocal relationships can lead not just to bias but “create the perception…that practitioners are being ‘bought' or ‘bribed' by industry.”
Since all it takes to create such a perception is an accusation, whether justified or not, maybe I'd better give back my Lilly box.
Warren Ross is editor at large of MM&M