0
Point and Counterpoint |

POINT: Should Academic Physicians Lecture as Members of Industry Speaker Bureaus? YesPhysicians on Speaker Bureaus? Yes FREE TO VIEW

Steven B. Greenberg, MD; Jeffery S. Vender, MD, MBA, FCCP
Author and Funding Information

From Critical Care Services (Dr Greenberg), Evanston Hospital, the Department of Anesthesia/Critical Care Services (Dr Vender), and Physician & Programmatic Development (Dr Vender), NorthShore University HealthSystem; and the Department of Anesthesia and Critical Care (Drs Greenberg and Vender), University of Chicago Pritzker School of Medicine, Chicago, IL.

CORRESPONDENCE TO: Steven B. Greenberg, MD, NorthShore University Health Systems, Evanston Hospital, 2650 Ridge Ave, Evanston, IL 60201; e-mail: sgreenberg@northshore.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Greenberg serves as a consultant for CAS Medical Systems, Inc FORE-SIGHT cerebral oximetry (2010-present) and received funds from Cadence Medical Partners/Cadence Health to perform the phase 3 randomized controlled trial: Efficacy of Intravenous Acetaminophen During the Perioperative Period of Neurosurgical Patients Undergoing Craniotomies (period of support, November 2011-present). Dr Vender serves as a consultant for PharMEDium Services, LLC and Covidien.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):250-252. doi:10.1378/chest.14-0685
Text Size: A A A
Published online

There is a wealth of evidence over the last 40 years to support the direct benefit to our patients of meaningful physician-industry relationships. Brilliant researchers and physicians have teamed up with industry to create new drugs and medical devices that are responsible for saving thousands of peoples’ lives.1 Recently, this relationship has come under fire. The Physician Payments Sunshine Act of 2010 mandates all medical product companies publicly disclose any financial transactions (with few exceptions) involving physicians and teaching hospitals on a national database.1 Compensation provided to speakers engaged in speaker bureaus must now be disclosed. It is ironic that this piece of legislation is considerably stronger than any law directed toward our elected officials, who engage lobbyists on a daily basis, who are devoted to their own agenda.

By one definition, speaker bureaus comprise a collection of physicians who are recruited by pharmaceutical, biotechnology, and medical device companies to convey information about products to other physicians for a specific monetary value.2 As academicians, we are under the presumption that those who are recruited are capable and have domain knowledge appropriate for educational purposes. Industry has been unfairly presumed guilty by public entities who accuse them of using the celebrity of physician speakers to promote biased information explicitly for financial gain.3 These same belittlers attempt to convince others that physicians who participate in speaker bureaus are subject to intense bias for the company product that will inevitably result in jaded judgment and inappropriate patient care.3 Paradoxically, “transactions between patients, insurance companies, hospitals, and doctors, encompassing 85% of the medical marketplace, do not count as conflicts of interest.”3 Alarmists focus on the innate human characteristic, “bias.” They clearly miss the importance of education, collaboration, and innovation that is often promoted by physicians involved in speaker bureau programs.

Bias can be defined as a propensity to present or believe in a partial perspective, while rejecting the possible merits of alternative points of views.4,5 Humans, in general, are innately biased.5 In fact, evolutionists often cite bias as a historical means for human survival.5 Negative experiences propel humans to become biased against those situations to avoid harm.5 Cognitive bias is the ability to make systematic decisions in certain situations based on cognitive factors rather than evidence.4 Confirmation bias is our tendency to give more credence to data that confirms what we believe to be accurate.4 These two types of bias are prevalent in medical research, education, and clinical practice today.5

Bias and conflicts of interest (COIs) are closely interconnected. COI situations are those that provide risk to professional judgment regarding a primary interest that could be influenced by a secondary one.6 Physicians should primarily focus on protecting the integrity of research, education, and clinical care. The secondary interest is typically the financial gain involved.7 The COI disclosures are given to audiences attending speaker bureau lectures so that attendees can decide whether the presentation and data are sufficiently rigorous to be adopted in their practice.7

National medical societies often promote the same speaker bureau physicians to participate in their annual meetings (because of their knowledge and reputation) as speakers that critics chastise for their so-called “biased view” and transparent COI disclosures. The major difference is that when these physicians are giving a lecture through a speakers’ bureau, the lecture is strictly regulated by the US Food and Drug Administration.3 Lectures delivered at national meetings have less restrictions and regulations on what is provided to the audience. Some of the most well-attended lectures at our national meetings are those laced with bias (ie, point-counterpoint debates and refresher courses by leaders in the field who have published research and are in favor of their life’s work). The audience decides what to believe and not believe. This holds true for any audience participating in an industry-promoted lecture.

Eliminating industry involvement in medicine or eliminating speaker bureaus cannot abolish bias. Physician bias creates varying points of view that may facilitate appropriate decision-making.8 Furthermore, bias may lead to innovative medical discoveries that would not take place unless those physicians clearly believed in their quest for improved patient care.8 The real problem is with those providers who allow their beliefs to inappropriately affect clinical care, which is based on sound evidence. This phenomenon occurs with both the industry-physician relationship and nonindustry ones as well.8 The handful of notorious cases of industry-sponsored physicians who were engaged in fraudulent activity is appropriately widely publicized. However, there are undoubtedly far more cases of non-industry-based fraudulent activities in medical practice.1,7 As an example, Steven Shafer, MD, editor-in-chief of Anesthesia & Analgesia, when referring to the fraudulent independent research performed by Joachim Boldt, MD, PhD, reported that “Not a single case, including this one [the case of Dr Boldt] has involved a study directly sponsored by a drug or device company.”9 He further wrote, “Sponsored studies are very closely audited, with each case report checked against patient and laboratory data.”9

There is little available evidence regarding the actual incidence of physician-industry-related fraud because the few notorious cases only comprise the numerator.1 The nonfraudulent, beneficial relationship occurring for decades between physicians and industry heavily outweighs the small numerator filled with cases of misconduct.1 Some reports suggest that > 90% of physicians have some type of financial interactions with industry (approximately 20% of them take part in consulting).10 These surveys connote that the denominator is quite large, making the incidence of fraudulent activity almost nonexistent.1,10 Similarly, there is no evidence that the incidence of adverse outcomes associated with academic-industrial interactions is mitigated at universities with more stringent regulations.8 A recent analysis of cardiovascular trials indicated that financial COI and source of funding did not impact outcomes.11

No malicious, fraudulent act should be tolerated in medicine or elsewhere. Mandating an official report from industry regarding contributions to physicians will not curb this problem. Similarly, banning academic physicians from participating in speaker bureaus will have little effect on eliminating bias that leads physicians to engage in inappropriate actions. As Thomas Stossel, MD, a proponent for academic freedom, from Harvard University reports, “Legislating integrity is impossible.”8 We believe it is simply too difficult to regulate ethics and morality.

To the contrary, legislation mandating public disclosure of funds received by physicians from industry (and speaker bureaus) may lead to the stifling of scientific innovation and progress. Physicians may not want to engage in speaker bureaus and other industry-supported events because of the concern for local, institutional, and organizational denigration. Signs of this concern are already occurring. Evidence from the Accreditation Council for Continuing Medical Education suggests that industry support for medical education is declining.1 Similarly, device approval by the US Food and Drug Administration has also declined.1 Whether the two are clearly correlated is not known. Creating more barriers between physicians and industry may result in reduced access to medical technologies that could potentially save more lives.

The societal push to ban speaker bureaus may result in wasted time and money that could be used to advance the practice of medicine. Speaker bureaus may provide an educational resource for providers throughout the United States, especially in underserved areas. First, these bureaus provide an invaluable means by which to educate medical practitioners, who may not otherwise have the resources to do so.1-3 They more appropriately enable physicians to educate other health-care practitioners, rather than rely on drug detailers doing so. Second, they may facilitate the safe adoption of a medication or device into a hospital by providing the hospitals’ providers with some personal experiences regarding the use of the individual drug or device.7 Third, they can lead to enhanced collaboration and communication between the audience members and the lecturer that may further lead to local and national patient care advancement. Fourth, industry substantially defrays the cost of educational events (such as speaker bureau lectures and national society meetings) that many health-care providers (and national societal organizations) would not normally be able to finance independently.1-3,7

Appropriate disclosures from physicians are continued necessities that allow others to make their own judgment regarding the validity of the information being discussed. Emphasizing and ensuring honesty and transparency may expose those who resort to misconduct. Subsequently, those who violate the trust or highest standards engendered in providing quality medical education should be appropriately admonished and disciplined.8 We must refocus our attention on the historically positive effect that the physician-industry relationship has on our ability to deliver quality patient care. It is now time to stop the trend of universally denouncing speaker bureaus and those who participate in them.

Abbreviations

AMC

academic medical center

CME

continuing medical education

COI

conflict of interest

FDA

US Food and Drug Administration

Stossel TP, Stell LK. Time to ‘walk the walk’ about industry ties to enhance health. Nat Med. 2011;17(4):437-438. [CrossRef] [PubMed]
 
Boumil MM, Cutrell ES, Lowney KE, Berman HA. Pharmaceutical speakers’ bureaus, academic freedom, and the management of promotional speaking at academic medical centers. J Law Med Ethics. 2012;40(2):311-325. [PubMed]
 
Stossel TP. Has the hunt for conflicts of interest gone too far? Yes. BMJ. 2008;336(7642):476-477. [CrossRef] [PubMed]
 
Wilcox C. Bias: The Unconscious Deceiver. Bloomington, IN: Xlibris Corp; 2011.
 
Cain DM, Detsky AS. Everyone’s a little bit biased (even physicians). JAMA. 2008;299(24):2893-2895. [CrossRef] [PubMed]
 
Committee on Conflict of Interest in Medical Research, Education, and Practice; Board on Health Sciences Policy (HSP); Institute of Medicine (IOM). Conflict of Interest in Medical Research, Education and Practice.Lo B, Field MJ., eds. Washington, DC: National Academies Press; 2009.
 
Kofke WA. Disclosure of industry relationships by anesthesiologists: is the conflict of interest resolved? Curr Opin Anaesthesiol. 2010;23(2):177-183. [CrossRef] [PubMed]
 
Stossel TP. Regulating academic-industrial research relationships—solving problems or stifling progress? N Engl J Med. 2005;353(10):1060-1065. [CrossRef] [PubMed]
 
Shafer SL. Shadow of doubt. Anesth Analg. 2011;112(3):498-500. [CrossRef] [PubMed]
 
Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med. 2007;356(17):1742-1750. [CrossRef] [PubMed]
 
Aneja A, Esquitin R, Shah K, et al. Authors’ self-declared financial conflicts of interest do not impact the results of major cardiovascular trials. J Am Coll Cardiol. 2013;61(11):1137-1143. [CrossRef] [PubMed]
 

Figures

Tables

References

Stossel TP, Stell LK. Time to ‘walk the walk’ about industry ties to enhance health. Nat Med. 2011;17(4):437-438. [CrossRef] [PubMed]
 
Boumil MM, Cutrell ES, Lowney KE, Berman HA. Pharmaceutical speakers’ bureaus, academic freedom, and the management of promotional speaking at academic medical centers. J Law Med Ethics. 2012;40(2):311-325. [PubMed]
 
Stossel TP. Has the hunt for conflicts of interest gone too far? Yes. BMJ. 2008;336(7642):476-477. [CrossRef] [PubMed]
 
Wilcox C. Bias: The Unconscious Deceiver. Bloomington, IN: Xlibris Corp; 2011.
 
Cain DM, Detsky AS. Everyone’s a little bit biased (even physicians). JAMA. 2008;299(24):2893-2895. [CrossRef] [PubMed]
 
Committee on Conflict of Interest in Medical Research, Education, and Practice; Board on Health Sciences Policy (HSP); Institute of Medicine (IOM). Conflict of Interest in Medical Research, Education and Practice.Lo B, Field MJ., eds. Washington, DC: National Academies Press; 2009.
 
Kofke WA. Disclosure of industry relationships by anesthesiologists: is the conflict of interest resolved? Curr Opin Anaesthesiol. 2010;23(2):177-183. [CrossRef] [PubMed]
 
Stossel TP. Regulating academic-industrial research relationships—solving problems or stifling progress? N Engl J Med. 2005;353(10):1060-1065. [CrossRef] [PubMed]
 
Shafer SL. Shadow of doubt. Anesth Analg. 2011;112(3):498-500. [CrossRef] [PubMed]
 
Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med. 2007;356(17):1742-1750. [CrossRef] [PubMed]
 
Aneja A, Esquitin R, Shah K, et al. Authors’ self-declared financial conflicts of interest do not impact the results of major cardiovascular trials. J Am Coll Cardiol. 2013;61(11):1137-1143. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543