The Boston Globe outlined the choice of a physician to leave a top Harvard teaching hospital, after the hospital adopted a policy restricting speaking for pharmaceutical companies.
Lawrence M. DuBuske, MD an allergy and asthma specialist and a Harvard Medical School instructor, announced he will resign from Brigham and Women’s Hospital and Harvard at the end of the month after 20+ years.
The hospital said. Dr. DuBuske, also runs a Gardner-based nonprofit organization called the Immunology Research Institute of New England, which sponsors education programs for doctors in Eastern Europe, according to its website. He speaks Russian, has published dozens of articles, and in 2004 won the Distinguished Fellow Award of the American College of Allergy, Asthma and Immunology, according to his and the Brigham’s websites.
According to the article, Dr. DuBuske was highly compensated for working with companies and during a three-month period last year, he earned $99,375 for giving 40 talks to other physicians last April, May, and June, almost one every other day.
This breaks down to approximately $2,500 per day, probably less than the amount of money a physician would earn in one day for seeing patients.
The article also noted that Dr. DuBuske works for six other pharmaceutical companies as a speaker, and he is a consultant for a half-dozen drug makers.
The reason DuBuske is leaving the hospital is because his extensive speaking for drug companies is “now in direct violation of a strict new conflict-of-interest policy for the Partners HealthCare hospital network, which includes the Brigham.” There was also one doctor, from McLean Hospital, that resigned because of the new rules that went into effect January 1, 2010.
Mary Anne Rhyne, US director of media relations for Glaxo, noted that “the company picks the topic and content of the talks in the speakers bureau program.”
Consequently, with “more teaching hospitals restricting or banning participation in speakers’ bureaus, it is unclear whether drug companies will cancel talks or turn to doctors without academic appointments, who are outside the rules but may not draw as big an audience of fellow physicians.”
Hospitals and health care institutions that are creating these policies are worried that physicians who “give company-sponsored talks may present biased information that could underplay harmful side effects or may encourage use of expensive brand-name medications instead of less costly alternatives.”
They should be more concerned at the potential long term detrimental effect these types of policies can have on recruitment and retaining top tier faculty. What may seem like a good idea today (banning everything without providing additional income, and limiting physician interaction with community physicians no matter who pays for the interaction) may have serious long term consequences on the quality of patient care both inside their institution and to the community.
In response to these policies, physicians such as Dr. DuBuske assert that doctors “who participate in speakers’ bureaus carefully screen the information for accuracy, and some doctors argue that working for numerous companies, cancels out bias in favor of any one drugmaker.”
In fact, Dr. Paul Appelbaum, director of psychiatry, law, and ethics at Columbia University College of Physicians and Surgeons, said that even though bias can be subtle, “it is possible to take money from a pharmaceutical company and deliver an unbiased talk.”
It should also be noted that the types of presentations that are specifically funded by drug companies are very different from continuing medical education (CME) programs. Presentations that are fully funded by industry are primarily different from certified CME programs because the company controls the content, whereas CME providers control the content even though manufacturing companies can provide educational grants.
Regardless of who sponsors the event, physicians must hear a variety of information from various sources so they can be aware of the newest breakthroughs and research to treat their patients with.
The fact that hospitals and institutions are restricting the involvement of physicians from speaking at these events will hurt other physicians who could learn from these experiences and share them with their patients. Hospitals and academic institutions need to understand that not every interest or working relationship constitutes a conflict, and that physician’s activities with industry represent a multiplicity of interests.