Posted on Monday 19 September 2011

Harvard Doctors Accept Fewer Speaking Engagements As Restrictions Tighten
The Harvard Crimson
By Tara W. Merrigan
September 09, 2011

The total amount of money pharmaceutical companies paid Massachusetts doctors promoting their products decreased in recent years—indicating that beefed-up conflict of interest policies are shutting down the profitable circuit of speaking engagements for Harvard doctors and other medical professionals. Total payments by pharmaceutical company GlaxoSmithKline in Massachusetts decreased from $1.2 million in 2009 to $884,850 in 2010. Eli Lilly, another drug company, saw a decrease in its fees paid from $1.6 million in 2009 to $866,910 in 2010. Many Harvard-affiliated doctors and researchers have cut ties with company speaking engagement bureaus, according to the Boston Globe…

“It’s not surprising that, as institutions such as Harvard say that these doctors and researchers shouldn’t be participating in these kind of speaking engagements, that doctors obey them,” said Medical School Associate Professor Eric G. Campbell, who studies the interaction of medical professionals and the health care industry. Campbell attributed this decline in part to a cultural shift among doctors. “For a long time in medicine, not just at Harvard, but everywhere, there was a culture that said doctors were entitled to industry perks, but that culture is breaking down,” Campbell said. “Doctors no longer assume it is their right and duty to accept these perks from industry.

The change has been reflected in institutional policy. Over the past decade, Harvard Medical School has revised its conflict of interest policy several times, but when a recent scandal made nation-wide news, the school implemented its strictest regulations yet. In June 2008, the Medical School was embroiled in debate after U.S. Senator Charles E. Grassley (R-Iowa) reported that psychiatrist Joseph Biederman of Harvard-affiliated Mass. General Hospital had received $1.6 million in consulting and speaking fees from the makers of drugs he had used to treat children for bipolar disorder…
I wonder if that’s right – that there’s a cultural shift among doctors. I’d like to think that’s true. My perception of things is different than Professor Campbell. In the past, all the little drug company trinkets and bobbles never felt very wrong to me. I’ve lived my life writing on prescription pads given by drug companies, using ball point pens from drug companies, using reflex hammers from drug companies. I never gave it much thought. If it affected my prescribing behavior, I didn’t know it. All the "throw-away journals" just got thrown away, along with the odd promotional book.

Somehow, the Speaker’s Bureaus, Advisory Boards, drug company "approved" presentations for big money, running a Clinical Research Center as part of a practice, etc. all seems a lot different to me than a rubber brain replica, a thumb drive with a corporate logo, or a ball point pen that actually works. Unless I spent the early part of my career among terminally naive physicians, I think the cultural shift that has become such a cancer, particularly in psychiatry, was something kind of new – maybe in the last twenty-five or thirty years. I know the first instance for me was in the mid 1980s when the infamous Dr. Borison gave a Grand Rounds presentation that was a Sandoz advertisement.

Then there was an influx around the same time of young psychiatrists to Atlanta who had trained in the mid-west. They all developed Clinical Research Centers sooner or later at hospitals or in their practices, something I’d never heard of before. After Dr. Nemeroff arrived at Emory, I thought they would all become pals, but I understand that instead they became competitors with studies at Emory – and that it sometimes became contentious. Who can ever predict how things will turn out? I know I always winced when they talked about "being in research." I never quite got it that drug trials were "being in research." In fact, I didn’t really understand the extent of the modern Clinical Research Industry until I got into it in the course of writing this blog.

So it seemed like an abrupt change that happened in my time in grade, something new. I wonder what made it all right for people to be so cozy with the pharmaceutical industry in the first place – to do their trials, to be KOL detail men, to give their talks, to involve themselves in their focus groups and advisory committees, to have a substantial drug company income. Psychiatry has always been one of the least lucrative of the specialties, but this new stuff has many living in a field of high cotton. I don’t really know exactly how that happened…

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