1 Boring Old Man

Put "pharmaceutical speaker bureau" into Google®. There, you’ll find a whole industry that you didn’t even know existed – Training Programs, Consultants, Search Firms, Strategies – a panoply of ways to access the exciting world of medical "experts" for hire. Now try "pharmaceutical speaker bureau psychiatry". It produces a very different kind of list. It’s a list of web sites mostly documenting abuses and exposés. I thought it would be different for Psychiatry, but I had no idea that it would be that different. It sure feels like the pharmaceutical industry has its fingers wrapped more tightly around Psychiatry than anywhere else in Medicine, and that it has become a bigger problem [with more corruption].

^{Over recent decades, medical schools and teaching hospitals have become increasingly dependent on industry support of their core educational missions. This reliance raises concerns because such support, including gifts, can influence the objectivity and integrity of academic teaching, learning, and practice, thereby calling into question the commitment of academia and industry together to promote the public’s interest by fostering the most cost-effective, evidence-based medical care possible…}

^{The Report acknowledges the new policy directions being implemented in many medical schools and teaching hospitals to address industry support of medical education, and it urges all academic medical centers to accelerate their adoption of policies that better manage, and when necessary, prohibit, academic-industry interactions that can inherently create conflicts of interest and undermine standards of professionalism…}

^{With the exception of settings in which academic investigators are presenting results of their industry-sponsored studies to peers and there is opportunity for critical exchange, academic medical centers should strongly discourage participation by their faculty in industry-sponsored speakers’ bureaus…}

¹_{The Task Force report and recommendations have been approved unconditionally by all Task Force members, with the exception of Jeffrey B. Kindler [Pfizer], Kevin Sharer [Amgen], and Sidney Taurel [Lilly]. Mr. Sharer supports the “explicit recommendations” of the Task Force, but “is not in a position to endorse the text” of the report.Mr. Sharer further states that “It is understandable that industry and academe will not agree completely on the final wording of any report given our differing roles in health care.” Mr. Kindler and Mr. Taurel support all but one of the Task Force recommendations, noting that “We do so without endorsing all of the supporting arguments used in the body of the report.” The recommendation of concern, in Chapter 2 under the heading of “Industry-Sponsored Programs,” actively discourages academic physicians from participating in industry-sponsored, FDA-regulated speaker programs. Mr. Kindler and Mr. Taurel further state that “We believe the reasoning for many of the recommendations is directionally correct, but more often than not the potential issues addressed reflect perceptions rather than proven consequences.”}

In an earlier post [the right direction…], I was complimenting the faculty at Michigan for deciding to no longer accept Industry Funding for their CME presentations. This post is about another aspect of the problem – faculty members serving as paid members of a Pharmaceutical Company’s Speaker Bureau. While the AAMC has strongly discouraged the practice, it is well and ticking as we speak. There’s a big conference today  at Georgetown on this very issue, given by Pharmed-Out, one of the watchdog groups working on this problem. Here’s an abbreviated syllabus showing the topics covered [I’ve included a few participants of note]. I hope they publish a transcript [or offer it as an on-line CME course]:

Actually, all of this is a very exciting development to me. Twenty-five years ago when I left academic medical education, it was around this very issue. I feel like I know why it happened, the invasion of the Pharmaceutical Industry into Psychiatry. At the time I left, funding Psychiatric Training was a nightmare. Federal funding dried up. State funding dried up. I spent a lot of time struggling to get salaries for our residents while maintaining high quality training. With the coming of a new chairman who was in the Psychopharmacology set, I left. I didn’t then realize that part of the reason for the change in Psychiatry to a more biological orientation was funding. Since there were no resources, the Pharmaceutical Industry money looked really enticing.