Pharma and physicians: It takes two to tango

Pharmaceutical companies are being scrutinized, and rightly so, for influencing physician behavior with sometimes immodest sums of cash and treats. Companies are starting to disclose and in some cases cap such payments. The latest example is GlaxoSmithKline, whose new CEO has announced plans to limit payouts to $150,000 per year per physician. (Of course most docs receive a lot less than that.) From the Financial Times (GSK to publish level of doctors’ advisory fees)

Andrew Witty, chief executive of the UK-based pharmaceutical company, said he was introducing tougher new rules to impose a cap “without exception” on such payments and promised to publish the amounts.

His commitment comes at a time of growing concern that the widespread practice of payments by pharmaceutical companies may help unfairly influence “key opinion leaders” in the medical community, in a way that biases their judgments and recommendations for particular treatments…

The pharmaceutical industry has taken steps in recent years to limit accusations of influencing doctors, curbing lavish entertainment and luxury travel under the pretext of supporting their attendance at academic conferences.

But critics continue to question payments to individual doctors as speakers and advisers to companies, as well as the drug industry’s heavy sponsorship of continuing professional medical education.

This article and others imply that pharmaceutical companies are solely to blame for the state of affairs and are being forced to open up under pressure. I don’t think that’s telling the whole story. In fact I doubt that Mr. Witty is upset about this turn of events.

Physicians are highly trusted professionals with great influence over patients’ lives. The decision to prescribe a drug is in their hands. Despite the rise of direct to consumer advertising it’s still the physician with the ultimate power to make the prescribing choice. That power brings a lot of responsibility, and it’s critical that physicians maintain the trust of their patients and the public. When they seek or accept high payments from pharmaceutical companies for access, consulting, or as an inducement for prescribing that’s not a great thing. Some who collect these fees are a bit ashamed by their own behavior, which is why voluntary disclosure doesn’t work well.

I know plenty of physicians who’ve decided not to accept payments from pharmaceutical companies. Every payment by a pharma company has a recipient on the other end. Let’s keep that in mind before bashing with such zeal.

October 23, 2008

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