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: firstname.lastname@example.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.
Dr Nathanson1 acknowledges the potential value of the physician-industry relationship. However, he is concerned that even the most ethical academic physicians involved in speaker bureaus might market rather than inform and teach. His predominant concern is the loss of trust from patients, other providers, and community due to this premise.1 Although abuses of the current relationships exist, should we eliminate or restrict participation by qualified physicians in speaking to colleagues while supported by industry?2,3
Physician involvement in speaker bureaus is prevalent.1 In spite of this fact, there are no definitive data supporting a lack of trust of physicians who are engaged in educational activities. A recent Gallup poll rated medical doctors in the top five of all professions when referring to honesty and ethical standards.4 Furthermore, Kawczak and colleagues5 reported in a prospective analysis of the continuing medical education (CME) data that no definitive evidence supported the notion that commercial support resulted in perceived bias in CME activities. The premise that physician societal trust has been reduced by physician speaker bureau participation has not been clearly validated.
Dr Nathanson stated that paid physician speakers often promote off-label uses of pharmaceutical products at speaker bureau-related events.1 Paid physician speakers must comply with all federal statutes and their presentations should reflect both the perceived benefits and risks of new products. In accordance with US Food and Drug Administration (FDA) regulations, speakers (including physicians) may only present and discuss FDA-approved indications for the drug.6 Major pharmaceutical companies such as Merck & Co, Inc; GlaxoSmithKline; Eli Lilly and Co; AstraZeneca; Pfizer, Inc; Johnson & Johnson Services, Inc; and Cephalon (Teva Pharmaceuticals, Inc) have repeatedly reported their clear stance on all speaker bureau-related information being in accordance with FDA regulations.6 Compliance with statutes and safety standards only improves the quality of presentations and their relevance.
Speaker bureau opponents support eliminating industry relationships irrespective of its potential value. If these contrarians wish to do away with speaker bureaus, then it would seem that other physician-industry relationships will be next on the hit list. Should industry sponsorship at national meetings be revoked? What about industry-funded research? Approximately 75% of clinical trials are funded by pharmaceutical companies.7 Others report that pharmaceutical companies account for nearly twice as much funding as the US federal government.8 What about other industry-backed CME activities? What about industry advertising in medical journals? Do we really believe it will be a benefit to medical education and research to eliminate industry relationships? If not, where do we draw the line?
Physicians have lived by the Hippocratic Oath for centuries. Eliminating speaker bureaus will have no effect on physician adherence to ethical and moral teachings of the Oath taken in medical school. Largely unsubstantiated fear of ethical compromise by speaker bureau involvement should not lead to elimination of this activity that has served as an important resource for education and collaboration. Elimination of speaker bureaus would most likely strain the coveted physician-industry relationship that Dr Nathanson confesses should continue.
Academic physician speakers should be permitted to disseminate scientific and clinical advice based on their expertise and understanding of the medical literature. All information must be accurate and source material should be disclosed, while “selling of products” condemned and reprimanded. With the appropriate disclosure of conflicts of interest, the audience can make an educated decision on what they believe to be biased. Physicians engaged in fraudulent activities should be disciplined. In our opinion, there continues to be a clear need for collaboration of physician speakers (experts) and industry. Don’t throw out the baby with the bath water!9
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