Chicago Tribune Asks Physician Educators Their Thoughts On FDA Regulated Education Sessions

The Chicago Tribune was one of the media sponsors who worked with ProPublica this week to publish stories about a report on payments from seven pharmaceutical companies to health care providers. Although the Tribune portrayed these payments in a negative light like most media sources did, they also asked 25 Illinois doctors and one nurse who received payments from drug companies about these activities. Their payments ranged from $73,000 to over $200,000, which was dependent on the time and expertise of each provider.

This kind of reporting is much more admirable, and follows the principles and guidelines of fair and balanced reporting. While several health care providers declined requests for comment or did not respond, the Tribune published a significant number of responses, which showed the overwhelming support of the highly beneficial and ethical nature of industry-physician collaboration.

Many of the health care providers who responded told the Tribune that they appreciated the “chance to teach colleagues about various illnesses and research supporting the use of medications.” Doctors further emphasized that the compensation they received “reflects the travel, preparation, and time away from patients and family often involved in giving talks.” Below are some of the comments.

Dr. David Guthman, an urologist and former chair of the department of urology at Northwest Community Hospital, speaks primarily about Avodart, for enlarged prostates, and Vesicare (Glaxo), for overactive bladders. He noted that “When the government approves new medications it’s crucial for primary care doctors to know when to use the drug, when not to use the drug and what’s the best way to use the medication to get the best results. … I do not get rewarded for my prescribing. … My job is to make my patients my No. 1 concern.”

Dr. Roueen Rafeyan, a psychiatrist in private practice and an assistant professor of psychiatry at Rush University Medical Center, speaks about Cymbalta (Lilly), used for depression and anxiety; and the antipsychotic medications Zyprexa (Lilly), Seroquel (AstraZeneca), Risperdal and Invega (Johnson & Johnson) and Geodon (Pfizer). She recognized that “Off-label discussions of any drug are absolutely prohibited.” She further added that “If at the end of these presentations my colleagues have gained some knowledge and are able to help their patients, my goal is achieved. For me, the personal satisfaction is most important, but if I’m compensated for my time it doesn’t hurt.”

Dr. Peter Toth, a family physician with specialty in preventive cardiology, speaks about the cholesterol-lowering medications Lipitor (Pfizer) and Crestor (AstraZeneca), the lipid regulator Lovaza (Glaxo) and Effient (Lilly), an anti-clotting drug. He recognized that “Speaking is extremely regulated and there are pluses to that. You certainly don’t want loose cannons saying things that exaggerate either the benefit or the risk. … I find it a little strange that institutions are fleeing these relationships when for decades there has been a very productive relationship between academic medicine and pharma.”

Dr. Merle Diamond, a headache specialist, speaks primarily about Imitrex and Treximet (Glaxo), both used to treat migraines. He noted, “If I’m uncomfortable, I will not do the presentation. There are certain companies I will not speak for because it is not fair and balanced. … My job is not to sell drugs — that’s the drug rep’s job. My job is to educate.”

Dr. Corey Goldstein, a psychiatrist, speaks about Seroquel (AstraZeneca), an antipsychotic; Cymbalta (Lilly), for depression and anxiety; and Strattera (Lilly) for attention deficit hyperactivity disorder. He acknowledged, “Much of any discussion is centered on clinical trials and evidence-based information as it pertains to medication within a disease state. There has been an ongoing push to ensure that medical practice is based on clear and pertinent evidence. … Providing educational programs in a variety of contexts has helped me to become a better clinician and researcher.”

Dr. Arcot Dwarakanathan, an endocrinologist, who speaks about Byetta (Lilly), Januvia (Merck) and Onglyza (AstraZeneca), all medications for people with diabetes. He expressed concerns over not having control over the content of his presentations but recognized that FDA rules prohibit speakers from comparing drugs “with other medications unless (researchers) have done a comparative study, which very few have.”

Dr. Sudhir Gokhale, a psychiatrist, noted that speaking allows him “to get to know more about the products. … I work with most of the companies but I feel I do not let that influence what I do (in my practice). Each medication has its unique personality. Making the right choice is a matter of clinical judgment.”

Dr. John Zajecka, a psychiatrist and associate professor of psychiatry at Rush University Medical Center, speaks about Cymbalta (Lilly), for depression and anxiety; Strattera (Lilly), for attention deficit hyperactivity disorder; and Seroquel (AstraZeneca), an antipsychotic. He chooses to speak to “educate primary-care doctors, community psychiatrists, and physicians from rural areas about disease states, diagnoses, and strategies to deal with their patients.” He further added that the “material I present has to be balanced. The boxed warnings, all the data on safety and tolerability, the failed trials, the positive trials, everything is there.”

Dr. Michael Davidson, a clinical professor of medicine and director of preventive cardiology at the University of Chicago Medical Center, speaks about Lovaza (Glaxo), a lipid regulator, and Crestor (AstraZeneca), a cholesterol-lowering drug. He acknowledged that his “talks focus on the mechanisms of cholesterol disorders. I seldom mention specific drugs and never off-label use. … I applaud transparency. But I also believe that the pharmaceutical industry needs support from academic thought leaders to bring forward innovative medicines and improve treatment.”

Dr. James Steven Marks, a psychiatrist in private practice, speaks about Zyprexa, an antipsychotic; Strattera, for attention deficit hyperactivity disorder; and Cymbalta, for depression and anxiety — all from Lilly. He noted how “Lilly gives us training and requires us to learn all the data. No other company has gone to the same lengths to give us the data and let us criticize what they do. … I like to have my voice heard as a professional seeing thousands of patients every year.”

Benita Lynn Baker, a self-employed nurse, speaks about Forteo, for osteoporosis, and Humalog and Byetta, for diabetes — all from Lilly. She acknowledged how all of the products she speaks about “are injectable medications, and patients have to be trained how to use them. … It’s very rewarding working with patients and health-care providers and assisting them to have better knowledge about disease states and these medications.”

Dr. Herand Abcarian, a surgeon and former chairman of the surgery department at the University of Illinois at Chicago College of Medicine, speaks about Entereg (Glaxo), a medication that helps the bowel recover after surgery. As a “main investigator for this drug’s trial at UIC, after the FDA approved it, speaking was a way of reaching doctors who didn’t know about it and also pharmacists and nurses. …This is a drug that works. I believe in it and it really makes a difference in patients’ lives.”

Dr. David McNeil, a psychiatrist in private practice, speaks about Cymbalta (Lilly), for depression and anxiety. He noted that he enjoys teaching and that “companies are very explicit that they don’t want shills, advertisements, infomercials. They want us to discuss the research and a little bit from our practice.”

Dr. Thomas Michalsen, a family doctor in private practice, speaks about Byetta (Lilly), for diabetes, and Chantix (Pfizer), for smoking cessation, among other drugs. He noted that “Being an independent physician these days isn’t easy and it isn’t fun. I have two offices and I’m the medical director for two nursing homes. Do I tell my patients about everything I do? No. I don’t see why that would change anything I do for them.”

Dr. Daniel Richard Wynn, a neurologist, who speaks about Treximet (Glaxo), for migraine; Nuvigil and Provigil (Cephalon), for excessive sleepiness; and multiple sclerosis therapies for Pfizer, expressed that the money he earns for speaking “offsets earnings that would go to the practice” he works for.

Dr. David R. Levine, a psychiatrist in private practice, now retired, expressed his dislike in being told what he could say and not say, a result stemming from new FDA regulations about commercial speaking.

Dr. David Kamp, a pulmonary/critical care specialist and professor of medicine and cell and molecular biology at the Northwestern University Feinberg School of Medicine, speaks about Advair (Glaxo), for asthma and chronic obstructive pulmonary disease, and Spiriva (Pfizer), for chronic obstructive pulmonary disease. He recognized that “These payments are for FDA-approved educational lectures on pulmonary disease that I give to doctors and health care providers around the country. I consider it part of my educational mission to teach my fellow physicians and health care providers.”

Dr. Michael McNett, a pain specialist, speaks about Lyrica (Pfizer), for neuropathic pain and fibromyalgia, and Cymbalta (Lilly), for depression and anxiety. He asserted that when “Lyrica was approved, and Pfizer contacted him, he thought it was a great opportunity to educate doctors and nurses. … We are under very strict orders from the company not to manipulate information presented in these talks. … I view this as an opportunity to provide a service that allows me to have an income commensurate with my non-primary care peers.”

Overall, these physicians understand that it is important for physicians to educate other physicians about therapies.  We would not want our physicians limited in their learning about these therapies from only a package insert, in the same way we would not want airline pilots learning about the new equipment they are flying from only a manual.