Are hospitals who limit ties with drug companies at a competitive disadvantage?

Doctors have been coming under increasing scrutiny for their relationships with pharmaceutical companies.

Many hospitals and medical schools have outright banned any involvement of their physician staff with drug companies. This isn’t a contentious issue most of the time.

But a recent case at Boston’s Brigham and Women’s Hospital raised some eyebrows. Apparently, an asthma specialist was so dependent on drug company money, that he chose to quit the hospital instead. According to the Boston Globe, “Out of thousands of US doctors hired by drug-maker GlaxoSmithKline to talk about its products, [this physician] was the highest paid during a three-month period last year, the company recently disclosed: He made $99,375 for giving 40 talks to other physicians last April, May, and June, almost one every other day.”

One talk every other day? That’s a lot of lucrative speaking gigs. In fact, he’s on the speaking panel of six different pharmaceutical companies.

But now, the Brigham lost an acclaimed physician — who likely would have no trouble finding work at another hospital with a less stringent conflict of interest policy.

In a lot of ways, this is similar to the college recruiting of athletes. Schools that have rigorous academic requirements put themselves at a competitive disadvantage athletically. The same could be said for hospitals, who risk driving away doctors by limiting their ties with drug companies.

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  • amy

    When did he have time to see patients or mentor or conduct research projects ?

  • J

    IIRC, physicians in Massachusetts are limited to earning a maximum of $5000/day from a pharmaceutical company; this is a fairly recent change. It’s possible to earn a handsome living even while continuing to practice, though this physician made a different choice.

  • stargirl65

    I am concerned that maybe he no longer had time for the practice of medicine. What was this hospital getting from him anyway? Just a name on a kiosk? Was he even practicing medicine at all?

    OTOH I am always leary of lecturers who spend more time lecturing than doctoring. They often seem out of touch with the real practice of medicine. Good riddance.

  • Academic Doc

    It’ not the hospital that’s hurt. It’s the medical school. This doctor was an allergist. Most allergic problems are treated in the clinic. The real issue is that pharma relies on doctors to do research and speak on their behalf to inform other doctors about their products. The doctors who are usually most knowledgeable and do the most research are the academic physicians. Academic physicians generally make a lot less than private practice docs. Many academic physicians do research for pharma to support their salary, and many consult/speak for pharma to supplement their salary to make up the difference.
    Ivory Tower institutions like Harvard and Yale are going to start losing out because some of the top academic physicians like the physician in question will likely go to other medical schools with less restrictive policies.
    I have looked at the entire list of docs on the GSK web site. This doctor was a huge outlies. Virtually all of the docs who got money from GSK only did a handful of talks receiving only 0.5% of what this doctor got.
    The real problem is that the United States has allowe pharma to support virtually all of its research and the vast majority of continuing medical education. You can’t have your cake and eat it too. If pharma doesn’t fund this, who will? Are you willing to increase your tax dollars so the government can do research on drugs or pay academic physicians to teach doctors already in practice about the latest medicines? Pharma currently spends billions on this. Though it could probably be done for a little bit less, are you willing to chip in?

  • jenjen

    Seriously, don’t let the door hit you on the way out there doc. I could see maybe wanting to keep someone like that on the payroll if they bring in grants. Problem for him now is, without his prestigious affiliation, will the drug companies still want him?

  • Dr. Lawrence Kindo

    It’s a darn good rendition of what is plaguing our doctor community in general. It’s not just the academic physicians that are in this game. Prescription practices are largely decided by aggressive pharmaceutical marketers targeting high-powered physicians in authority with bonuses and gifts. It is true even of the general physician who spends few hours at the private clinic. It is becoming more than a reality even in the developing countries. Spurious drugs are increasingly being sold without much ado – thanks to numerous companies that are out there for the money.
    Let’s not point fingers at the Academic physician alone while we just watch prescriptions given in a frenzy to earn that extra buck or gift.

    A rational approach would be J’s approach at Massachusetts IIRC, physicians in Massachusetts are limited to earning a maximum of $5000/day from a pharmaceutical company

  • Cheryl

    Only in medicine would such a debate even get started. Imagine a tort judge who is also a paid speaker for the automotive industry, or a stock broker who is also a paid speaker for a mutual fund. Anybody in medicine have any concern at all about ethics? Fact of the matter is that MD’s do not have to do this research. Biologists and other pure scientists can do it and hire out the medical care on a contractual basis, thus avoiding any appearance or fact of conflict of interest, but because the medical lobby is so powerful the ethics are basically nonexistent, just like in politics, so we have doctors selling themselves to the highest bidder while trying to convince us that they have the patient’s best interests at heart. Sorry, it does not work that way.

    I got brain damage from a drug and my neurologist refused to file an adverse event report, then he admitted in his next breath that he was a paid representative of the company that made the drug, which was why he knew that it categorically could not have caused my brain damage. He never did explain where my movement disorder came from but he did get angry when I told him he was a crook.

  • Dana

    As someone who was a pharmaceutical representative for many years, I have a different opinion. Unfortunately, this is generally a very black and white subject.
    I was not a typical rep, though. I wanted to be a doctor, chose not to apply to med school and thought I’d be able to impact patient lives via my involvement in the Pharmaceutical Industry.
    In the case of my territories, I had large rural areas where often there was limited or no access to specialists. Paying an Endocrinologist to speak with the Primary Care providers in my territory was essential for them to understand more about the treatment options available to provide care to their patients’ diabetes. Most of those patients would never see a specialist and relied upon a PCP for all their information.
    I can’t recall a single time that a physician retained to speak did a “commercial” for my products. At times, it was the opposite and supported the use of a generic product vs. the brand.
    Perhaps this was not the norm over the past 2 decades, but I honestly believe the Pharmaceutical Industry is earnestly trying to change this perception.
    In the end, the patients are the losers. My Oncologist is a practicing clinician (limited patient hours), a Med School preceptor, and an avid researcher. He has almost no ties to industry because of his affiliation with his hospital. I went to him because of his brilliance and his reputation as Indiana’s leading Lymphoma expert.
    If he were to speak for the pharmaceutical industry, I would have no problem because it also likely means he has access to greater volumes of information regarding late-stage products in development and clinical trials that can benefit his patients.
    Even so, he knew the difference between not recommending the use of Neupogen/Neulasta for my cancer vs. other lymphomas. I still benefited from the representatives being in the office and providing him the necessary information about the proper use of the product.
    The erroneous perception in this country is that most of our innovation is coming from institutions. In reality, it’s coming from Industry and the brilliant scientific/medical departments who discover and bring new products to market.

  • jekorman, lcsw

    Unfortunately this is an issue that has emotional tie-ins that have little to do with the “real” ethics of the situation. On the one hand there is the notion that people in the health care professions should be selfless givers, eschewing the Faustian bargain held out by Pharma and other funders, and taking comfort in knowing that we do “good work.” On the other hand is the need for us to be able to have access (which means time as well as means) to new thought, new techniques, new procedures, be able to participate in research, while still doing front-line work, whether that’s direct contact with patients, students, or other practitioners.

    We read about the excesses and presume that’s all there is. We each have our biases for or against Pharma (sometimes with good reason, sometimes just a knee-jerk.) Someone needs to fund research. Someone needs to fund medical treatment. Someone needs to fund medical education. The insurance industry isn’t doing much of any of those. There are excesses, to be sure, but let’s be careful where we put our righteous indignation. The cost of research can be high. The cost of education can be enormous. The cost of ignorance is without measure. Perhaps we need better funding for research and education so those of us in the helping professions don’t have to take subsidies so we can afford to participate in research or disseminate our knowledge.

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