Tuesday, November 27, 2007

Dr. Carlat's True Confession: 199,999 More to Go


Dr. Daniel Carlat knew his career as an industry-sponsored speaker (aka, industry ho) was over when the Wyeth district manager (aka, pimp) who first hired him said: "My reps told me that you weren't as enthusiastic about our product at your last talk. I told them that even Dr. Carlat can't hit a home run every time. Have you been sick?".

That is just one of the many tidbits into the life of an "industry-sponsored (MD) speaker" Carlat offered in a lengthy New York Times Magazine story published this past Sunday (see "Dr. Drug Rep").

"Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep." Sidekick does not accurately describe the relationship between pharma reps and MD "consultants." With all due respect to Dr. Carlat -- who at least has confessed his past sins -- I prefer ho.

Dr. Carlat, a practicing psychiatrist, newsletter author, and anti-pharma blogger over at The Carlat Pschiatry Blog, first came to my attention when he wrote an NY Times OpEd piece about CME (see "Welcome to the CME Laundromat!"). I even invited him as a guest on my Pharma Marketing Talk podcast show (listen to it here).

I feel a little betrayed that he never disclosed to me his past as a paid consultant to the pharmaceutical industry, which raises the question: Should the other 199,999 physicians that Carlat estimates receive money from pharmaceutical companies also come out of the closet and reveal their current or past ties to the industry?

This kind of disclosure is something I have called for in the past (see "Dollars for Docs: More Scrutiny Needed") and my readers wholeheartedly agree (see figure at left; you can give me your opinion by taking the poll yourself:

Should Pharma Companies Report Physician Consultant Fees?
Yes, we have a right to know
No, that's confidential business information
No, that's up to each physician to reveal
Not sure
I really do not expect pharmaceutical companies to voluntarily rat out their MD hos, er consultants. Maybe there should be a call from the AMA for that or for doctors to reveal their ties so their patients can know. But, as Dr. Carlat points out, the AMA is part of the problem:
"The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money."
Like many physicians, Dr. Carlat claimed to have been "astonished at the level of detail that drug companies were able to acquire about doctors' prescribing habits." As if it were some kind of trade secret! Duh!

Is a Book Deal in the Works?
So, one physician has disclosed details of his past life as a drug industry "consultant," "sidekick," "ho," whatever. Any comments from the 199,999 others? I'm not holding my breath for that. But I am expecting Dr. Carlat to write a tell-all, semi-fictional book about his experience in a similar vein to Jamie Reidy's book "Hard Sell: The Evolution of a Viagra Salesman" (see "Generation X Pharma Reps").

Some Numbers
BTW, the NY Times Magazine piece includes a graphic illustrating how one paid "consultant" can help a drug company get about 25 new patients on medication per lunch-and-learn physician the consultant influences. This costs the pharma company $500-$750 paid to the consultant (an "honorarium"), $100 for the lunch, and maybe $400 for rep expenses. Total = $1250 or $50 per new patient. Considering that Effexor must be taken for years and years, that's quite a return on investment! Dr. Carlat should have negotiated a much higher honorarium, IMHO!

1 comment:

  1. Dr. Carlat’s assessment of how the industry sponsors CME was a bit off but unfortunately that small inaccuracy is important. The initial impetus for CME grants is not driven by marketing and this predates the Senate Finance Committee findings. Firewalls between marketing and MedEd departments are in place and marketing influence on CME from concept to content is, for the most part, tightly controlled and restricted.

    MECCs on the other hand do know where their bread is buttered but they too must still go through the same ACCME standards for accreditation and content approval as Dr. Carlat. This fact was overlooked in his interview.

    It seems that Dr. Carlat’s knowledge and perception of industry sponsored CME comes from his own personal experience and likely indiscretions of the past. It's unfortunate that he would try to make up for his past by now becoming an outright critic of the system instead of a constructive voice for change.

    Clearly oversight improvements can be made in CME but much good can still come from industry CME grants.

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