As part of an ongoing series about how money and conflicts of interest affect medicine and patient care, the Milwaukee Journal Sentinel recently wrote that “As universities tighten ethics policies, drug firms turn to private physicians to promote products.”

They used the example of Tara Dall, a Delafield primary-care doctor who entered private practice in 2001. Dr. Dall has worked with GlaxoSmithKline.   According to the authors, she is one of the “most highly paid of more than 3,600 doctors nationwide who spoke for the company,” earning $45,000 for three months of speaking engagements last year. Interestingly, Dall does talks for five other drug and medical companies in addition to GlaxoSmithKline as well as community talks, which go to show that she is not just biased to one company.

Critics of speaking engagements believe that the payment leads the talks to be biased “and contribute to spiraling health care costs by promoting the use of expensive brand-name drugs over generics.” Such a claim is completely off mark because without such events, doctors would be unaware of new medicine and treatments to offer their patients. In fact, regardless of the price, doctors have a legal and ethical duty to their patients to offer them whatever options are available, and attending speaking engagements increases such options.

The fact that drug companies seek out “influential university doctors with impressive credentials to bring their message to other doctors and persuade them to write prescriptions for their products” mischaracterizes the relationship of industry and academia. Industry and physicians work together in a partnership to bring patients better options and healthier lives first and foremost, and making a profit is what keeps such relationships afloat.

Opponents of speaking that also believe talks can lead to “off-label prescribing” easily forget the fact that it is legal for physicians to do so, and such a choice is based on clinical data and studies.

While “a growing number of medical schools, including the University of Wisconsin-Madison, have developed conflict-of-interest policies that ban such talks” these policies are not only restricting free and protected speech, but are hurting patients and physician training. Consequently, the author of this article then tries to assert that such policies should be used to restrict private doctors. How can we restrict what private individuals do on their own time?

Dr. Dall noted that she would disclose if she were to use anything off-label, her website lists the fact that she speaks for pharmaceutical companies, and she “absolutely discloses her work to patients.” Does that constitute something illegal or unethical? As a private practitioner, physicians are held to the same legal and regulatory requirements as any academic researcher, and perhaps face more exposure and liability because of the direct treatment of patients. If a doctor like Dall was not confident about her prescribing choices, she would end up sued or lose her licenses, something that keeps her habits in line with the applicable standards of care. 

Part of the Sentinel’s work comes from an investigation last year which found “that there was little disclosure to patients of drug-company moonlighting among dozens of doctors at the UW School of Medicine and Public Health.” So what does that have to do with private practice? It seems like they are just trying to drag everyone under the bus.

They try to discredit Dr. Dall’s work by pulling a quote from one of her speaking engagements and ripping it apart through commentary from Steve Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, who has been paid by pharmaceutical companies as well. The article tries to portray Dall as stating that “drugs can wipe out a cardiovascular disease.” Most likely, she was just emphasizing the important role drugs can have in reducing the risk and effects of the disease.

Disclosure and Transparency

The portrayal of Dr. Dall is the unfortunate result of media downplaying important information about the speaking events, and only using the money that various companies (as we have previously written) have decided on their own to release regarding payments to doctors. Instead of detailing the important details and clinical data that doctors receive at such events, the article only portrays them as “massive marketing of drugs and financial ties between doctors and drug companies.”

The fact that other firms including – Merck, Eli Lilly and Cephalon – also have listed payments to doctors for parts or all of 2009 activity is encouraging for the public to see why patients benefit from doctors collaborating with industry. Moreover, having more than 10,000 doctors and other health care professionals from around the country, working with industry should show to the public it is not only a widely accepted practice, but one that has true merits, otherwise why would so many take an unnecessary risk.

Critics may say its for the money, but the reality is gaining new information from such speaking events and industry is the real value for them. As highly trained professionals who are constantly updating their training and learning, it would be a shock if such physician’s sole motivation was money.

In fact, the article highlights this very point, by quoting Rod Halvorsen, a private practice obstetrician/gynecologist in Manitowoc who got $61,000 during the first nine months of 2009. He told the Sentinel that he does not speak for the money, but because “he has a passion for the topic because his mother died as the result of osteoporosis.”

Despite committed work, critics continue to believe that speaking events use doctors to boost sales. These doctors however, are doing the right thing by sharing their experience and information with their colleagues and peers to help them continue learning about new ways to help their patients.

Ultimately, the overwhelming majority of physicians speak out of altruistic motives for working with industry because they want to help their colleagues and patients. The fact that companies look for respected, qualified experts who are good presenters, is enough evidence that speaking for private physicians does not need to be restricted because such highly trained professionals know the difference between science and advertising. As a result, private physicians who speak are and need to remain crucial to speaking events because "Sharing information on complex disease states is important to advancing patient care, and health care professionals often learn best from their peers and colleagues."