Two days ago (January 1), I posted the contents of a letter to the editor of the Wall Street Journal from a physician criticizing the "Big Pharma Lecture Circuit." Today's WSJ has a response from another physician:
As a physician who occasionally lectures on behalf of industry, I must respond to Jon C. Bowersox's insulting comments ("Concerns About Big Pharma Lecture Circuit," Letters, Dec. 29), where he likens us to traveling snake oil purveyors of old.
Lectures done in the context of a pharmaceutical promotional event, such as a dinner, follow strict guidelines established by the FDA. They are anything but opinion-based -- data from pivotal trials is presented and recommendations cannot differ from those that have been FDA-approved and are contained in the package insert. Personal opinions may emerge during Q & A, but how is this a problem? Apparently, Dr. Bowersox thinks physicians who attend such meetings are dull clods and cannot make their own minds up about a specific recommendation.
And perhaps the good professor can explain how $2,500 for a lecture that often requires one or two days away from the office or hospital is an "outrageous fee?" It barely covers lost income.
Richard Amerling, M.D.
Editorial Board
Nephrology News and Issues
New York
Ah yes, the poor pharma-supported lecturer barely covering lost income. And where do patient interests fit into this discussion?
Posted by schwitz at January 3, 2007 08:57 AM | TrackBackI appreciate you including my letter to the WSJ on your blog, and I hope that it will lead to introspective, rather than defensive, dialogue.
Dr. Amerling's response to my letter is the very reason that physicians need to begin policing ourselves rather than letting regulators do it (as has happened with Sarbanes-Oxley, where corporations couldn't institute internal controls on their own). It is also a typical response I hear, either out of defensiveness or ignorance.
The FDA does regulate what physicians can say, but only if a pharmaceutical company employs them - otherwise, you’re on your own (and note that pharma does NOT dictate what guest lecturers say - they may not be invited to talk again if their content doesn't add value to a company's marketing efforts, but they aren't censored). Taking the high road by saying that only pivotal trials are discussed, but then saying that personal opinions are expressed during a Q&A is more confused thinking - lecturers are recognized as "thought leaders," and mixing data with opinions is a commonly used approach to muddle the two.
Practicing physicians generally spend hectic days seeing patients, not sifting through very complex statistical analyses that are characteristic of current multi-center trials. There recommendations are clouded by marketing - OTHERWISE INDUSTRY WOULD NOT SPEND BILLIONS ON MARKETING BUDGETS! - Take a business course or two and come back to me on that one.
And, that is $2,500 for a dinner talk - not bad for after work. Out of town trips pay a lot more. And, if someone is taking home $2,500 a day from seeing patients, they are doing much better than the rest of us in practice.
I propose that American physicians take a year-long moratorium on speaking for Pharma - a time for critical introspection and assessing values. Debate about whether evidence-based decision-making is better (it is). Look at what we really owe our patients, and if one needs to make additional money to make ends meet, find an area that does not involve one's specialty to do it in.
Dr. Jon Bowersox