Sometimes all it takes is an appearance of impropriety to raise suspicions.
That is exactly what happened to Dr. Peter Libby, the chief of cardiology at Harvard’s Brigham and Women’s Hospital who had taken money from drug companies to consult and lecture because of his growing and glowing reputation.
The compensation ranged from a couple thousand dollars to tens of thousands to help drug companies with the development of drugs and to craft solid drug trials.
He never owned stock in a company he consulted for and Dr. Libby knew his associations were above board.
Libby even invested four years of his time, pro bono, to help create an educational public television series, “The Mysterious Human Heart”. He was proud of the project which he hoped would educate the public on how to prevent heart disease.
After the series was broadcast last October, the criticism started from those who see the world in white and black, not shades of grey as Dr. Libby had.
Bloggers immediately took the issue of lucrative pay from drug companies as a sign that Dr. Libby’s opinion was in some way tainted, bought and paid for.
“That was a wake-up call for me. I was singed in the blogosphere” he tells the New York Times.
That is when Dr. Libby decided he would no longer accept payment from the pharmaceutical industry to lecture or to act as a consultant. It just wasn’t worth it to be under suspicion.
“I want to speak out about the beliefs I am passionate about regarding prevention and medical advances that I think can reduce disease and save lives,” he told the Times.
Kelly D. Brownell of Yale was offered $50,000 to be on an advisory board of a manufacturer. In his position as director of the Rudd Center for Food Policy and Obesity at Yale, he had helped consult food companies on policy and obesity. But then he began to wonder – were the associations tainting his objectivity?
He made a decision to just say no.
Dr. Eric P. Winer of the Dana-Farber Cancer Institute at Harvard stopped taking honoraria because he was tired of having to see a disclosure next to his name that he had accepted honoraria.
He also decided that the Susan G. Komen for the Cure group could be hurt by seeing the asterisks next to his name that he had accepted cash for consulting.
There is not a lot of money here says Dr. Winer to the New York Times. His honoraria ranged from $2,000 to $3,000 for attending a board meeting for a day or two.
“I’m responding to a societal pressure” Dr. Winer told the Times who also says he resents the fact that he had to make that decision to say no to legitimate research opportunities with major companies.
Until recently, decisions like this were unheard of.
For decades, pharmaceutical companies have showered billions on the nation’s academics, medical doctors and researchers. Perks included everything from free pens to wide screen televisions, trips to Hawaii and golf resorts.
Last year, the New England Journal of Medicine reported 94 percent of doctors polled said they had “direct ties” to the drug industry.
In the study, first national survey to gauge the depth and extent of the relationship, 1,662 practicing physicians were found to be recipients of perks such as honoraria for consulting, lecturing or enrolling patients in clinical trials.
Author, David Blumenthal, MD of the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School said, “I know it’s cliché, but if it didn’t work, drug companies wouldn’t do it. It appears pretty clear that industry forms tighter relationships with doctors who are really the thought leaders, the ones who are likely to affect the behavior of other doctors."
So what’s the solution?
Doctors have had a lot of latitude in policing themselves and for those who don’t just say NO, the American Medical Association and the American College of Physicians have suggested limiting gifts to doctors from industry.
Pharmaceutical Research and Manufacturers of America suggest gifts be limited to $100 in value. The AMA says the gift should benefit patients and not the doctor.
Introduced into Congress last September, the Physician Payments Sunshine Act would require large manufacturers of pharmaceuticals and medical devices to disclose the gift and its value.
Minnesota and Vermont already have made the reporting of such a relationship mandatory. Minnesota has limited giving to $50 worth of meals or gifts per year per doctor. Primary care doctors are reportedly seeing fewer drug reps as a result.
Maine, West Virginia and California are among 17 states that have drafted legislation regulating gifts to doctors and/ or their disclosure.
"There are signs of a building momentum to restore a sense of medical ethics, a sense of service to the patient, to our profession," says Howard Brody, M.D., director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston tells the AARP Bulletin in January.
Looking at different state policies on compensation to doctors, the consumer group, Public Citizen reports the legislation falls short in the areas of disclosure and enforcement.
For example, West Virginia has no enforcement and only Minnesota makes the information part of the public record.
Since this is a national issue, Public Citizen’s Dr. Peter Lurie is encouraging a national across the board reporting requirement for the disclosure of any financial exchanges involving doctors and drug and device manufacturer.
Facing a threat of forced disclosure, a dozen of the leading drug and device makers are now working on plans to publicly disclose grants on their company web sites.
This after Sen. Charles Grassley, R-Iowa and Sen. Herb Kohn, D-Wisconsin introduced a bill requiring medical drug and device makers to disclose anything of value given to doctors such as gifts, travel or payments.
Watchdog groups believe the companies are just trying to avoid legislation that would require public disclosure and transparency.
"If they were doing this out of the goodness of their heart, they would have done so decades ago," said Dr. Lurie of Public Citizen.
The eventual goal is for consumers to be able to find out which doctors take what from industry so they can evaluate the credibility of medical advice they receive.
But without drug reps how then could a busy doctor find out about the latest drugs on the market?
A group of doctors has that covered. PharmedOut.org is a web site run by physicians for other physicians and prescribers to offer unbiased information on drugs and insight into the marketing strategies of drug companies without the influences of pharmaceutical companies.
allegedly show insiders talking about how drug reps convince doctors to try the drugs they are selling. #