DC City Council Holds Hearings on Area Physicians Relationships with Industry
The District of Columbia City Council Committee on Health last month held a hearing regarding various health care related issues. Included in the hearing was “charges” read out by Health Committee Chairman David A. Catania. These included reading the names of physicians (top researchers in the district) along with information on their relationships with industry credited as provided by a specific member of US Senator Charles Grassley (R-IA) staff.
The meeting gives us a glimpse into the current state of “transparency” where at one point Mr. Catania reads off “charges” against six area physicians who’s crimes are that they worked for industry. This included sending subpoenas to all six physicians to show up a hearing on December 19, 2009. He also provided warnings to local universities and hospitals that they should adopt to severe conflict of interest restrictions or face the consequences.
(The codes next to the section titles outline where on the computer video the information is located and you can advance by moving the slider bar at the bottom of the video.)
The Evils of Pharmaceuticals (00:00 – 24:00)
The first section was a 20-minute monologue from Mr. Catania based on his “research” cataloging the evils of the pharmaceutical industry. He attempted to label industry negatively by talking about the industry-disproportionate profitability, but most likely he was talking about gross, not net profits.
As a result, his remarks totally ignored the fact that pharmaceutical companies actually need such profits to continue driving innovation, especially when the average drug can take 12-15 years and cost over $1 billion to make.
He describes the pharmaceutical industry as equalvalnt to the tobacco lobby, (doesn’t pharmaceutical save lives?) and describes how the current DC restrictions have moved meetings and dinner meetings outside the city and then considers their moves as boycott as opposed to being created by himself.
Instead, Mr. Cantina tried to claim that public investment is what drives medical innovation however, as we have reported numerous times, the overwhelming majority of new drugs comes from industry funding. Although to Mr. Catania’s credit significant amounts of public monies are spent on research, (The R side of R&D) that does not translate to development of a new drug. The significant financial risk of drug development largely falls into the hands of private biotech and pharmaceutical companies.
He also exaggerated the amount of money spent on marketing expenditures by such companies by claiming such expenses could be used to insure all citizens in DC. Besides the fact that such expenditures are less than 5% of most company’s budgets, there is nothing wrong with advertising and selling a product. When was the last time a politician complained about the tens of millions of dollars spent campaigning? Couldn’t all that money be spent on insuring people too?
Academic Detailing (24:00 – 1:13:30)
The second part was a rally for academic detailing, for which Catania has appropriated funds for a small program in DC. In addition to warm remarks by Catania, four physicians and two detailers spoke. The direction of the program comes from Harvard Medical School (an overstatement “Harvard” is Jerry Avorn, MD who owns a small business the Independent Drug Information Service IDIS providing academic detailing services using Harvard faculty who moonlight for the IDIS) providing “evidenced based education” and dedicated to promoting generics.
The testimony included a roll play where a physician working for IDIS in the district gives an example of a "evidenced based" detail. It was interesting that the roll play based on details the city uses to educate physicians on diabetes was pretty light on "evidence" at one point the detailer kept stating that generic metformin was the "drug of choice" and went on to describe all the potential side effects of branded pioglitizone but none of the side effects of the generic drugs.
Catania stated that he would like to see such programs, which currently are funded in only three constituencies, spread nation-wide. His ideas of changing this practice were particularly misguided considering most proprietary medical product marketing is, by definition due to FDA regulation, evidence-based. He did point out that DC’s academic detailing program had two full time employees to reach 2,000 physicians.
It is also interesting to note that Cantania kept repeating that I hope will do a program soon on "HIV" as this is an important issue to the district.
He also failed to mention that the academic detailers are being paid for what they do or that the obvious emphasis on generics represents a interest when the government is the payer.
The Show (1:13:31 – 1:45:19)
The final interval was another monologue from Mr. Catania showcasing what he claims are insufficient or unclear disclosure of industry funding by DC physicians. He credits the information to hold this part of the hearing was provided by the Grassley Committee in his efforts to expose conflicts of interest.
First, Mr. Catania summarized the litany of Grassley’s already well-publicized investigations of psychiatrists. Interestingly, none of the six physicians he asked to attend this part of the hearing appeared, although most responded in a written statement.
The physicians that were asked to testify were extremely important researchers collaborating on breakthroughs in HIV, cholesterol, and other diseases that affect tremendously large populations in America. What Mr. Catania specifically forgot to mention in outlining some of these doctors payments was that industry is providing the necessary resources and funding to create the breakthroughs in these areas because of how critical they are to public health. Consequently, his remarks came off similar to the sensationalist headlines from journalists who only look at the numbers, instead of the potential impact the work these doctors performed will have in curing diseases and making people healthier.
Ironically, such potential is probably the exact reason why such information is confidential. Although Mr. Catania read a confidentiality agreement from a company that one doctor had provided, his explanation was misguided. Simply asking for what work the researcher did and how much he was paid is not as straightforward as he thinks. In fact, other than a general description (e.g. consulting, testing, writing), chances are that a physician cannot explain what tests they were conducting or exactly what they worked on without talking about highly protected industry information.
Ignoring such obvious reasons why physicians would not want to list payments for fear of the exact thing that happened at this meeting, Mr. Catania announced that he had requested industry funding amounts and consulting contracts of selected DC physicians, presumably provided by the Senate staff.
He then focused on several quite prominent DC academics, who were vilified for failure to respond at all or for having legal counsel mount objections to responding and what Mr. Cantania considers to be disclosure failures or irregularities.
The session then ended with Mr. Catania announcing that he would sign subpoenas intended to force the delinquent physicians to appear before him and that he planned to work on DC academic health centers to tighten up disclosure requirements.
In the end, this hearing represented a serious misunderstanding of the relationship between physicians and industry, especially for those doctors with significant reputations.
While Mr. Cantania believes such physicians have the power to impact public perceptions regarding the efficacy of drugs, he even stated himself that “some relationships may be “benign,” and that he was not eager to end such relationships.
He went on further to state that he did not want to use “a broad brush” to paint all physicians who work with industry as being wrong, even though that’s exactly what his tone and his hearing portrayed.
As a result, the amount of time, energy, and taxpayer dollars spent on investigating such irrational claims of the “potential” for conflict will only hurt patients more by deterring physicians from taking part in critical research. For a politician who had trouble pronouncing conditions correctly, and who misspoke of a company’s name repeatedly, to criticize the legal and ethical right to advance medicine by researching new drugs is troublesome.
The District of Columbia faces serious problems attracting talented physicians to the city (Does he think these hearings will help the situation). The real problem for DC is not who is listening to pharmaceutical reps or who is speaking and consulting for companies but the disparities in patient care and access to physicians.
For city council members to be spending two hours of a monthly health committee hearing to discuss the “evils” of the pharmaceutical companies, this seems like a misappropriation of their time and a loss of priorities.
If and when the hearing reconvenes (which may happen on December 23rd) with the physicians present to testify it should be interesting to see exactly how Mr. Cantania responds to the fact that the work of these physicians saves more lives and money than his investigations will ever accomplish.