Speakers need to explicitly state financial relationships

I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.

Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.

Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was reliably followed by all presenters … in the following manner: “Here are my disclosures” — PowerPoint slide flashes on screen with a list of pharmaceutical/device companies. Yet, by the time the speaker finishes speaking those four words, the slide deck has already advanced to the next slide. I, and my fellow audience members, didn’t even have enough time to read the disclosures, let alone process them.

Now, I have no problem with pharmaceutical sponsorship of biomedical research. Nor do I wish to criticize physicians for accepting industry funds. However, I do feel strongly that all such financial relationships must be completely transparent.

Personally, I feel that transparency is not achieved by quickly flashing a slide in front of an audience. No, transparency requires not only that each speaker’s financial relationships be read out loud, but that any connection between these relationships and the subject matter being discussed should be explicitly stated. We as audience members should not have to connect the dots and look up which pharmaceutical companies manufacture which drugs; rather, we should expect that these connections will be made for us.

What would such transparency look like in practice?

For example, if a speaker is giving a talk on novel oral anticoagulants for use in atrial fibrillation, the talk should begin with the following statement:

Today I’m going to talk about the use of oral direct thrombin inhibitors and Xa inhibitors. I would like to disclose that I receive consulting fees from Boehringer Ingelheim, maker of dabigatran, Bayer, maker of rivaroxaban, and Daiichi Sankyo, maker of edoxaban.

That’s it. Short and sweet. But now, when the presenter proceeds to discuss the clinical use of dabigatran, rivaroxaban, and edoxaban, I know that he has a financial connection to these drugs.

There has been great progress towards transparency recently, including the passage of the “Sunshine Act,” which mandates that drug and device manufacturers participating in federal health programs publicly report payments to physicians and teaching hospitals. Yet, such transparency will only be meaningful if it is presented clearly, and in a manner easily understandable by the public.

Explicitly stating (out loud) financial relationships between speakers and the topics they discuss would be a good start.

James Colbert is an internal medicine physician who blogs at MedPage Today’s The Gupta Guide where this article originally appeared.  He can reached on Twitter @jcolbertMD.


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  • Dr. Drake Ramoray

    At the Endocrine Society and AACE meetings there is either a hard copy or electronic file that includes all of the speakers and a clear listing of their financial relationships. I have never done so, but in this setting I can skip a speaker if I choose to do so, but at least Im going into it with my eyes open.

    I suppose if that is too hard for some societies we can mandate that speakers where uniforms like Cyclists that have their sponsors all over them. We mandate everything else. Why not. /s

    • querywoman

      Drake, see the above about my derm.
      Drug companies reward doctors. For now, that’s the way it is.
      I have no problem with docs who really help their patients who get a bounty from the drug companies.
      For all I know, my derm is giving a ton of money to charity, and he probably is.

  • GT

    Likewise, I believe that websites, blogs, individual bloggers, and highly-quoted “thought leaders” in medicine should be subject to the Sunshine Act, and be required to disclose all of their sources of funding, whether it’s from commercial or government sources.

    A highly-quoted medico from a prominent and respected university, and a widely-linked medical website, both of which receive taxpayer dollars from the Obama administration to promote the ACA, come to mind.

  • Suzi Q 38

    I looked up all my doctors on the “Pro Publica” website.
    It shows how much money is paid to various doctors in your state.
    I was surprised at one doctor of mine.
    In over 3 years, he received about $30K from a major pharmaceutical company. This was for consulting, speaking, travel, and meals.
    You only need the doctor’s name and state to look him/her up and find the information.

    I was pleased that most of my physicians received nothing.

    • Dr. James Colbert

      Yes, Pro Publica’s website is a great tool for those interested in finding out about physician payments from pharmaceuticals. We all benefit from greater transparency, and I think the Sunshine Act is a step in the right direction.

    • querywoman

      I’m not clicking, “like,” on your post cause some docs who get drug money deserve every penny and more!
      I don’t know if meds are the great treatment you need for spinal stenosis, but you’d just love it if you found a doctor who could really treat spinal stenosis!
      You were a drug rep, Suzi Q! Are you trying to unemploy drug reps?
      You know that drug money is neither good nor bad, depends on the person receiving it!
      My dermatologist is amazing. I think he would be quite wealthy without it. Some of his $$$ is inherited.
      I don’t think any of my other doctors are as committed as he is to a special mission.

      • Suzi Q 38

        “……You were a drug rep, Suzi Q! Are you trying to unemploy drug reps?……”

        Yes, I was a pharmaceutical rep long ago in my “other life,” LOL. Let’s just say that I saw a lot of money, “gifts,” and dinners passed out. The reason? To promote whatever was the drug of the month. I don’t regret all of it, as it was the “cost” of doing business, but I regret a good deal of it. Some drugs were promoted aggressively, and money was not a problem.
        I would just write “promotion” under the reason for spending $400.00 on a CME luncheon at the teaching hospital, and that was that.

        I have no power to employ or not employ drug reps, as the companies are doing that themselves. There have been company closures, mergers, etc….layoffs have been aggressive for the last 15 years. The pharmaceutical workforce has decreased considerably on its own. Besides, there are so many additional ways to promote drugs. The Internet is only one way. Another way is television ads.

        Don’t get me wrong, I love a new drug that works well.
        Drugs that save are to be praised.

        All drugs work, including generics. Some new drugs are just reincarnations of older, generic drugs. No big deal, yet we were expected to “sell it.” I won’t get into the specifics, but some drugs were not very good. Others had dangerous side effects that were overlooked and continued to be promoted.

        That is the side of pharmaceuticals that I do not like, and I am somewhat concerned about.

        I can see your point.
        For example, a neurologist who makes money at a teaching hospital may not be as much of a concern as
        one who gets paid speaking all over the place.
        If they are traveling and speaking on behalf of a pharmaceutical company, and the honorariums are substantial, I will check it out.

        I will probably look at the drugs he is prescribing for me.
        Is it because he is paid so much to speak for a certain company, or is this really the best drug for me?

        It’s O.K. that you do not push the “like” button.
        We do not always have to agree.


        • querywoman

          Ha! Confessions of a drug pusher!

          Thank you!
          As long as the system exists as is, my derm can get all he can work enough to earn!
          I’m seeing him tomorrow. I’ll try and remember to say something to him about looking him up and being in the pockets of drug companies. He’s probably had some very expensive meals. Recently, there was a very expensive per plate dinner honoring him.

          He prescribes a mix of old and new, including cheap old doxepin. There’s new brand form of doxepin, a lower dose for sleeping. Of course, it’s very expensive. I’d rather take the smallest dose capsule, which I have it, break into the capsule and use part of it!
          Sadly, for him and those of us with skin disease, it takes forever for insurance companies to put expensive new skin meds on their formulas.

          • Suzi Q 38

            You’re welcome.
            Doxepin is an old, old drug. The brand name was Sinequan. I am not sure it is indicated as a sleep aid. One of it’s major negatives was that it made people sleepy. Can’t you just ask for an additional script of the Doxepin in a lower dose for your desired use?
            I wouldn’t pay for the brand drug.
            I ask my pharmacist for the name of a generic equivalent every time now.

          • querywoman

            What I was implying is that I am the lowest dose, 10 mg. It is being sold as a sleep aid in a lower dose, maybe 7 mg, under a brand name and costs more.
            The first time I used it, an allergist prescribed it as a liquid so I could adjust the dose.
            Getting back to dermatology and research, most skin diseases are poorly misunderstood and we badly need new treatments for them.
            Skin disease is always blamed on “picking at it.” I get tired of that, even at the derm’s office, and I tell him and the derm residents so!
            He is very committed to his skin disease patients. He has a mild chronic skin disease himself, and others in his family have worse cases.
            Any crumb we derm patients get is a treat.

          • querywoman

            SILENOR is the new lower dose form of doxepin peddled as a sleep aid. Of course, it’s much more expensive than the generic doxepin.
            It costs so much more to make a lower dose med and put it in new packaging.

          • querywoman

            Suzi Q, the new Silenor in 3mg tabs cost $180 to $190 for 30 days.
            10mg doxepin generic capsules are $4 for 30 days, $10 for 90 days.
            Pity you are not pushing drugs anymore and benefitting from the trickledown of Silenor, though this one would probably really irritate your personal ethics!
            There’s also the option of the slightly more expensive generic liquid doxepin, the way it was first prescribed for me.
            I’ll take the cheapest, splitting the capsule open, over the liquid doxepin, if I want less.
            I think doxepin is being used in Germany now to help heroin addicts sleep.
            I laughed with my dermatologist about all his drug money today

  • querywoman

    My well-respected dermatologist gets some, but he’s a generous man. He’s also truly wealthy.

  • querywoman

    My dermatologist gets so much drug money it’s hard to believe how he gets the energy to be the treating, teaching busy doctor he is.
    Pretty good for a senior citizen!
    I don’t know how he farms down the work, but he is a well-respected specialist in certain diseases.
    I hope that I have found a suitable replacement in his cadre of residents for the day that boy finally retires!
    It takes a certain mentality to be the kind of doctor he is, that is one who is committed and on a mission.

    • querywoman

      My derm may be the only one of my current docs who is in the AMA. Most of the endocrinologists around here dabble into research, but some are more heavily into it and getting more drug money.
      I have a nice guy team of two endos now. When I call, there is an option to select on the phone for the research department.
      These two have written papers on diabetes together in the past.
      I hope they get some of the drug money and get some “statements” made, but I don’t think are into making a statement as heavily as the derm is. I doubt they would pay to be in the AMA.