Journalism usually entails an objective search for the truth. Members of the press search for real issues affecting the public and the public’s interests, and then “investigate” by seeking out information through research, interviews, and other methods of data collection. Recently however, journalists all over the country are making their paychecks by writing stories about the paychecks of others, specifically, physicians, nurses, and other health care providers.
Not only are these journalists being paid to write stories about what payments doctors receive from working with industry, they are not doing any of the investigating themselves about the sources where the information is coming from, and the background of physician-industry collaboration. While many of the local papers have included quotes from the physicians whose payments and names they are discussing, that is only the bare minimum requirement for journalism. Almost none of the articles bring to light the valuable research, discoveries, and improvement in patient care and physician training that has resulted from industry-physician relationships.
Journalists over the past several weeks have relied on the ProPublica website, which amounts to nothing more than a “Google Search” for physician’s names and the companies they have worked for. While companies who report such payments only indicate there general nature (i.e. consulting, education, travel), many media sources do not explain the significant benefits these relationships have for improving physician training and education, which lead to better patient care and outcomes.
There is no question that transparency measures are valuable, and we agree they are important for the public to know why doctors value collaboration with industry and have such partnerships. It is a critical that patients have access to this information to ensure their doctors are making decisions in their best interest, however, this does not excuse careless reporting of only dollar amounts, and not the real value behind industry-physician collaboration.
For example, the Sun News in South Carolina titled their story “Docs paid to talk up drugs.” But that’s a completely misleading title. Doctors are paid to educate and train physicians about the use of new drugs, in comparison to other treatments. Moreover, there needs to be a clear distinction that most of the payments doctors are being paid for are for bona fide services that meet stringent FDA regulated policies.
The article lacks any sense of objectivity, and instead begins to draw a connection with the publication of these payments to the Medical University of South Carolina considering toughening its conflict-of-interest policy. The publishing of these payments does not show they are bad because the school is making a new policy. That is what the authors want readers to think. The reality is that many universities have had policies in place for a long time and simply did not enforce them or find a need to change them. It is only after media critics, without any evidence of harm to patients, suggest that these payments are unethical by quoting anti-industry people, that such miscalculated connections are drawn.
Defending these relationships, Dr. Ricardo Fermo, an expert in psychopharmacology who speaks for Eli Lilly, Johnson & Johnson and Pfizer, noted that he gives talks to primary care doctors and nurses in rural parts of the state where they otherwise might not hear about new drugs. He explained that the payments create no conflict of interest for his practice, where he and his colleagues prescribe medication based on the patient’s specific needs. Dr. Fermo recognized that his expertise is not about one company, but about getting the right medications to suit the person regardless of which company produces it.
Dr. Ward Katsanis, a Charleston-area gynecologic oncologist who works for GlaxoSmithKline, said he speaks only about drugs he strongly values. Additionally, Dr. Aljoeson Walker, an assistant professor in MUSC’s department of neurosciences, said he feels duty-bound to do prescription-drug consulting. He noted, “As an academic physician, I consider it my responsibility to teach and instruct inside and outside of the university.” Doctors also told the Sun News that payments do not influence prescription decisions.
Syracuse, New York
The same kind of biased reporting took place in Syracuse, New York, where the title of their article was the same: “51 docs paid to talk about drugs.” Such misleading titles leave readers no choice but to decide that there is something wrong about this arrangement, or as if this conduct had no benefit whatsoever. Why not choose a neutral title such as “Physicians Collaborate with Industry?”
Dr. David Schwartz, a psychiatrist at Upstate Medical University noted that if a product helps people, and he believes in it, it is a win-win situation. Dr. David Albala, chief of urology at Crouse Hospital and a prostate cancer expert noted, “Morally my goal is to treat the patient with the best medications I know of.” Dr. Albala added, “I find it hard to believe some people would write a (prescription for) a medication just because they are a speaker.” He noted that his visits to specialists who otherwise would not have access to his expertise are so worthwhile, and that such payments do not influence prescribing decisions.
Erie Pennsylvania
The same biased title appeared in Eire, Pennsylvania, “Docs paid to talk about drugs.” While the purpose of such a title is to suggest something is wrong with physician-industry collaboration, Gurjaipal Kang, M.D., who discusses a heart drug or a medical device like a coronary-artery stent, said that there is no conflict of interest in his work. In fact, he noted that he speaks for competing drug companies, and about some drugs that he often does not prescribe.
Critics of such payments such as Catherine DeAngelis, M.D., editor of the Journal of the American Medical Association, told the Chicago Tribune these speaking arrangements posed “a conflict of interest” and threatened to put doctors’ “own financial benefit before that of the patients who trust them.”
However, two Erie endocrinologists said DeAngelis’ assessment simply is not true. Luis Aparicio, M.D., and Joseph Hines, M.D., physicians who both received payments from drug companies to give presentations on diabetes drugs to family physicians and internal medicine doctors noted that the process is all very regulated. They further recognized that in these presentations, they “talk about the benefits and the side effects.
Dr. Aparicio also noted that drug companies who pay him to speak never pressure him to prescribe particular drugs and that “it’s up to each physician to make their own decision about prescribing the drug.” Dr. Hines recognized that discussing drugs and medical devices, especially newer ones, with other physicians fills a vital need, and is “a significant educational opportunity for these physicians.”
Dr. Hines also made an important point: if doctors were curtailed from attending such events or such events happened less frequently, “where would they get this information? There are only so many hours in the day, and doctors are more bogged down than ever.”
New Hampshire
In New Hampshire, the headline was even more misleading, by only stating that “Three doctors paid $100,00 plus from drug companies.” What is unfortunate about this title is that it does not adequately capture the fact that many of the payments were for “health care professional education programs,” programs that trained and educated physicians to the benefit of patients.
Nevertheless, critics such as Dr. Leonard Korn, president of the New Hampshire Psychiatric Society, feel that physician-industry payments “don’t feel right.” He noted that it was an “image” thing more than anything else, and that there is bias associated with presentations. Without doing any investigating, the article did not address the fact that commercial support of CME has been associated with almost no bias in three extremely large studies conducted this year (Cleveland Clinic; Medscape, and UCSF).
Instead, the article quoted Dr. Korn talking about how promotional education used to be. Yet the article did not clarify that much of what he talked about, (i.e. payment for attendance, expensive meals, gifts, etc.) have been prohibited for several years. Had Dr. Korn gone back to a program more recently or if the article had researched policies such as PhRMA’s, they would have realized this. However, exaggerations are more interesting to media.
While Dr. Korn said there is an inherent conflict of interest at issue “to influence a doctor’s prescribing patterns,” Dr. Craig L. Donnelly, chief of the child psychiatry section at Dartmouth-Hitchcock Medical Center, disagreed. Dr. Donnelly asserted that such appearances are part of his mission to educate the next generation of physicians. He acknowledged that when he gives talks, “he advocates not for one particular drug but for a “full range of treatment options,” including non-pharmacological ones.”
Dr. Donnelly added that when he speaks to colleagues, he is putting his reputation on the line, and that he would not do so if he did not “genuinely believe that these talks provide educational value to his colleagues in primary care, above and beyond the informational component on the particular drug topic.” Moreover, Donnelly noted the pharmaceutical industry is responsible for advancing new medicines, and that requires collaboration with top experts and researchers. Outside advisers can give drug companies “critical feedback on the safety, efficacy, and planned use of newly developed agents,” he said.
Douglas Noordsy, associate professor of psychiatry at Dartmouth Medical School, who works with three companies, noted that it is important for practitioners “to have timely, accurate, and complete information about the range of treatment options for conditions that they treat so that they can provide appropriate counsel to their patients.” Dr. Noordsy added that “Engaging a physician who has expertise and broad experience in a therapeutic area to assist in that communication has advantages over it coming from a pharmaceutical representative or from an advertisement.”
Another benefit from physician-industry collaboration that Dr. Noordsy recognized is that
“consulting for drug companies is personally rewarding because it gives him a chance to give the companies feedback and encourage them to develop needed treatments. It also helps him learn about their data and research.” Meeting with other practitioners, he added, “helps him stay in touch with the challenges being seen by his colleagues on the front lines of clinical care.”
Dr. Carl DeMatteo, an infectious-disease physician and chief quality and compliance officer at Dartmouth said academic physicians who share their research with pharmaceutical or medical-device companies “can bring forward treatments and cures to the public that can make a real difference in people’s lives.”
New Jersey
In New Jersey, the trend of biased titles continued with an article entitled Drug companies paid N.J. doctors millions to promote their products.
However, as Les Burns, an obstetrician-gynecologist in New Jersey noted, doctor’s work with industry ultimately helps patients. Dr. Burns added that his speaking engagements do not compromise his judgment, noting that he used the same vaccines before he became a speaker for the company. He asserted, “I use the medications because I have considerable experience, I know the side effects and benefits, and I am able to communicate that well to doctors and staff. I am not a salesman. I’m all about education.”
Scott MacGregor, spokesperson for Eli Lilly USA, called the practice of hiring doctors “a critical part of Lilly’s mission to improve individual patient outcomes.” He further recognized how “many health care providers prefer to learn about treatment options from their peers and professional colleagues.” This is an important collaboration for everyone involved because “These health care professionals have invested years developing their knowledge and experience and bring a critical clinical perspective, which is highly valued by other health care providers and patients.”
Discussion
What is common about all of these articles is that blanket statement they use, indicating that getting “paid by drug companies to talk about their product isn’t illegal.” However, the focus of these articles do not discuss the reasons behind why such payments are legal or valuable, or how they educate and help train doctors about new treatments, new clinical trial data, side effects, adverse events, and other information. The discussion of such payments and relationships do not list the numerous breakthroughs that industry-physician relationships have created, and the impact such breakthroughs have created. For example, there is no discussion about how products that treat heart disease, cancer, or chronic diseases like asthma or diabetes—all created through industry-physician collaboration—have increased life expectancy, and reduced death rates and symptoms significantly. While the quotes from physicians who work with industry are important, the message still seems to be that such payments are wrong.
One problem with this criticism is that in commercial speaking events (not accredited activities), the attorneys at pharmaceutical and device companies review every word of every slide to ensure that the slides are “on label.” These attorney’s have to approval all slides and other materials physician-instructors use at educational gatherings to ensure the information’s veracity. The information presented to physicians, who voluntarily attend such events, are highly regulated and not only include the indications and benefits of their medications, but also all adverse side effects. Therefore, these programs are fair and balanced, and much of the lecture content is helping physicians better understand a particular disease or treatment.
Additionally, as many doctors pointed out, payment for these services are at fair market value, and deserved, especially considering “any money earned doing education is less money than can be made in private practice.”
Still, anti-industry critics such as Adriane Fugh-Berman, who directs Pharmed Out, an anti-industry group, feel that the payments being published are further evidence why the relationships should be limited. She feels that patients who know their doctor works for industry will prescribe for their patients for the wrong reason. However, as Houston Endocrinologist Dr. Eric Orzeck noted, “doctors have their patient’s best interest in mind when prescribing.”
Dr. Orzeck clarified that “speakers work together to further the education of other physicians and it’s no different from a college lecturer being paid for time and knowledge.” He asserted, “What I’m doing is educating physicians about the product, about the medication so they’ll be better able to use it,” and that all goes to the best interest of the patient. Moreover, as Jeff Francer, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, told the Chicago Tribune that many of the activities tracked (e.g., giving doctors drug samples) were “perfectly appropriate and in the interest of patients.”
Conclusion
In the end, journalists need to be more objective about reporting the legal and ethical work of doctors. Using sensationalist titles and biased reports provided by partisan groups such as ProPublica only perpetuates the idea that physician-industry relationships are wrong, when it is clear from the numerous quotes above that doctors value their work and service through such partnerships. Moreover, there needs to be more discussion about the historical importance of physician-industry collaboration to bring about the role these partnerships have played in constantly improving patient care and outcomes.
Without the full picture, the public cannot understand the information they are given, and if the media continues to attack physician-industry relationships, patients will end up suffering when such relationships start to dwindle, and the advances and improvements in health care decrease as a result.