By Bruce W. McNulty, MD
This article is part of our MedRIB project and was published October 23, 2009.
Friday, October 23, 2009
A recent editorial in The Boston Globe recently came out strongly against the practice of doctors being paid to be on â€œspeakerâ€™s bureaus.â€ The piece can be seen at: http://www.boston.com/bostonglobe/editorial_opinion/editorials/articles/2009/10/01/keep_doctors_independent_ban_fees_from_drug_makers/
The concept of a speakerâ€™s bureau is simple: a business pays a professional to speak on their behalf to other professionals, ostensibly to provide information on advances in the field. However, it is widely understood that an additional intent is to influence behavior. Given that many pharmaceuticals can only be given with a doctorâ€™s prescription, the significance of influencing a physicianâ€™s behavior in this respect is huge. The editorial goes on to discuss the large sums of money paid by Eli Lilly to physicians in the state of Massachusetts, as well as nationwide. The company also provides information to the physician who then speaks at hospitals and conferences. Although it is now required that these relationships be disclosed, and lack of bias is promised, bias is difficult to prevent.
Not addressed, but equally concerning, is the fact that many of these physicians are prominent opinion-maker clinicians at the best teaching hospitals. In an earlier blog post, we discussed the concept of evidenced based medicine. That implies that the very best medical and research evidence is incorporated into clinical practices. In the most practical way, physicians use guidelines provided by different organizations to help guide them about how best to treat their patients. But can a physician who is paid by a company to be part of a speakerâ€™s bureau truly be objective when reviewing research evidence as part of an expert panel? And if the speaker is not objective, then this could result in having an unhelpful influence on other physicians.
I applaud the Globeâ€™s editors for their stance on this issue. They are right. If physicians are to work in the patientâ€™s best interests, they should not be paid by drug companies to lecture to other physicians about how to care for their patients. This practice needs to stop.