speaker bureaus…

Posted on Friday 25 June 2010

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].

In June 2008, the Association of American Medical Colleges [AAMC] convened a Task Force – Industry Funding of Medical Education. A few excerpts:
    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…
Note that the Task Force recommends that "academic medical centers should strongly discourage participation by their faculty in industry-sponsored speakers’ bureaus." However, in a footnote to the first page of the Executive Summary, it says that this recommendation was not universally supported by the members of the Task Force:
    1The 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.”
Three dissenters might seem a surprise until you consider that only four of the thirty voting members of the Task Force were from Industry [including all of the dissenters]. Everyone else represented academic medicine proper – 100% supporting the recommendations. Notice the dismissive comment in the footnote, "more often than not the potential issues addressed reflect perceptions rather than proven consequences." Well I can’t speak for other branches of medicine, but in Psychiatry the "proven consequences" are all over the place [like in our little exercise in the first paragraph of this post].

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]:

Prescription for Conflict:
Should Industry Fund Continuing Medical Education?


Friday, June 25, 2010
Georgetown University
Intercultural Center Auditorium
Washington, DC


Opening Remarks

    Thomas Insel, MD, Director, National Institute of Mental Health, National Institutes of Health
Drug Companies and Medical Knowledge
What’s Known About Industry Influence on Continuing Education of Prescribers?

    Daniel Carlat, MD, Associate Clinical Professor of Psychiatry, Tufts University School of Medicine, Editor, Carlat Psychiatry Report
Professionalism
Federal Views
    Joshua Sharfstein, MD, Principal Deputy Commissioner
    U.S. Food and Drug Administration

    Paul Thacker, Senior Investigator
    Office of Senator Chuck Grassley

Bioethicists and Pharma
Views from Former Insiders
Pros and Cons of Industry-Funded Education
Is Industry-free CME a Sustainable Model?
Next Steps-Discussion

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.

I thought it was a bad direction to move in, even back then, but I couldn’t tell you the alternative. Psychiatry is not one of the lucrative medical specialties. People with Major Psychiatric Illness are often disabled. Many mental illnesses are chronic – manageable but not curable. And treatment may not be lucrative, but it’s expensive to the consumer. Public funding comes and goes. So Psychiatry was ripe for the financial support offered by the Pharmaceutical Industry. For that reason [money], reform is not going to be easy in Psychiatry, but that’s no reason not to do it. In fact, it’s long overdue. More to come on this topic…
  1.  
    June 25, 2010 | 1:48 PM
     

    What a change — and in a tragic direction. In 1963, when I was a psychiatry resident at Emory, the federal government had created a special grant fund for people “retraining” in psychiatry, part of a governmental effort to build up the ranks of psychiatrists.

    Because I had done a GP residency and then spent 3 years as an Air Force GP, I was eligible for the “retraining” grant. So for my second and third years of residency, I got a larger stipend (I think it was $16,000 — but, hey, this was almost 50 years ago). Plus, it came directly from the government and, I presume, freed up Emory training grant money to be used for others.

    People fret about “governmental takeover.” As far as I could tell, there was NO negative side to that program. I much prefer it to turning our education over to the drug industry.

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