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Point and Counterpoint |

Rebuttal From Dr NathansonRebuttal From Dr Nathanson FREE TO VIEW

Ian Nathanson, MD, FCCP
Author and Funding Information

From Humana.

CORRESPONDENCE TO: Ian Nathanson, MD, FCCP, Humana, 838 Lake Catherine Court, Maitland, FL 32751; e-mail: inathanson@cfl.rr.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):256. doi:10.1378/chest.14-0688
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In defense of allowing academic physicians to be members of speakers’ bureaus, Drs Greenberg and Vender1 make the case that the real enemy is bias. They even state that humans are innately biased, and the “real problem is with those providers who allow their beliefs to inappropriately affect clinical care, which is based on sound evidence.”1 I agree that when bias trumps sound evidence we have major problems in any field, including medicine.

However, what puzzles me is the leap that because we are biased it is somehow okay for academic physicians to use slides and other materials supplied by marketing divisions. Do Drs Greenberg and Vender honestly believe that marketing divisions select speakers solely based on their expertise? In her book Our Daily Meds, investigative reporter Melody Petersen2 points out that marketing guru George Silverman stated that “your entire sales force making calls for an entire year may not be as effective as one trusted expert recommending your product at a conference. Companies spur prescriptions by getting a physician to tell his peers about the benefits of a new drug.” In October 2007, Daniel J. Carlat, MD, testified before the Massachusetts State House and recounted his experiences as a member of speakers’ bureaus. He described his “lunch and learn” sessions, rationalizing that he was there to educate and not sell. He further testified that a district manager promptly visited him, inquiring as to why he was not enthusiastic about a product when he revealed “less than glowing information about a company drug.”3 In 2005, the US Justice Department testified before Congress that it had launched 180 separate investigations of marketing practices of pharmaceutical companies. In 2010, cardiologists published a point/counterpoint about the role of industry-sponsored education, but both sides agreed that speakers’ bureaus should be avoided.4,5

Although the missions of industry and academic medical centers differ, I think academic-industry collaboration is essential. I do not oppose industry support of physician education provided appropriate firewalls are in place. The value of such oversight cannot be underestimated to protect physicians from becoming mouthpieces for industry, which is what a physician becomes when employed by a company’s marketing division. Drs Greenberg and Vender link the physician-industry relationship being under fire with the mandated financial disclosures required by the Physician Payments Sunshine Act of 2010. Perhaps the message is that the most powerful regulatory body in the United States no longer trusts us to ensure that we always have our patients’ best interests at heart.

Finally, Drs Greenberg and Vender assert that “it is simply too difficult to regulate ethics and morality.”1 I agree with this assertion, but, as I wrote, ethics is not the issue; the issue is trust. We cannot ignore that patients, students, and colleagues are wary of our ability to separate ourselves from a cozy relationship with industry, particularly the marketing divisions. When professional societies, coalitions of academic centers,6 lawmakers, proponents of strong academic-industry relationships, students, and colleagues suggest that we avoid speakers’ bureaus, maybe we should listen.

References

Greenberg SB, Vender JS. Point: should academic physicians lecture as members of industry speaker bureaus? Yes. Chest.146(2):250-252.
 
Petersen M. Our Daily Meds. New York, NY: Sarah Crichton Books, Farrar, Straus and Giroux; 2008.
 
National Legislative Association on Prescription Drug Prices. Testimony of Daniel J. Carlat, M.D. NLARx website. http://www.reducedrugprices.org/av.asp?na=347. Accessed April 10, 2014.
 
Avorn J, Choudhry NK. Funding for medical education: maintaining a healthy separation from industry. Circulation. 2010;121(20):2228-2234. [CrossRef] [PubMed]
 
Harrington RA, Califf RM. There is a role for industry-sponsored education in cardiology. Circulation. 2010;121(20):2221-2227. [CrossRef] [PubMed]
 
Association of American Medical Colleges. Industry Funding of Medical Education. Report of an AAMC Task Force. AAMC website. https://members.aamc.org/eweb/upload/Industry%20Funding%20of%20Medical%20Education.pdf. Published June 2008. Accessed April 10, 2014.
 

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References

Greenberg SB, Vender JS. Point: should academic physicians lecture as members of industry speaker bureaus? Yes. Chest.146(2):250-252.
 
Petersen M. Our Daily Meds. New York, NY: Sarah Crichton Books, Farrar, Straus and Giroux; 2008.
 
National Legislative Association on Prescription Drug Prices. Testimony of Daniel J. Carlat, M.D. NLARx website. http://www.reducedrugprices.org/av.asp?na=347. Accessed April 10, 2014.
 
Avorn J, Choudhry NK. Funding for medical education: maintaining a healthy separation from industry. Circulation. 2010;121(20):2228-2234. [CrossRef] [PubMed]
 
Harrington RA, Califf RM. There is a role for industry-sponsored education in cardiology. Circulation. 2010;121(20):2221-2227. [CrossRef] [PubMed]
 
Association of American Medical Colleges. Industry Funding of Medical Education. Report of an AAMC Task Force. AAMC website. https://members.aamc.org/eweb/upload/Industry%20Funding%20of%20Medical%20Education.pdf. Published June 2008. Accessed April 10, 2014.
 
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