Thursday, November 21, 2013

The Slippery Slope of Pharma Physician Phreebies

Most physicians do not seem to know that "there is no such thing as a free lunch." Medscape's 2012 Ethics Report survey, for example, revealed that 72% of 23,710 physician respondents answered "Yes" to the question "Do you feel that you could be unbiased with prescribing habits if you accept lunches from pharmaceutical representatives?" (see here).

But, according to other researchers, such thinking is a "slippery slope" on which "Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance" (see "Physicians Under Pharma's Influence: Are Physicians Powerless Pawns of Pharma Psychology?").

While the general public is concerned about the cost of insurance under the Affordable Care Act, physicians are concerned about the Physician Payment Sunshine provision of the law, which requires pharma companies to report many kinds of payments to physicians, including the value of "free lunches." That information will be made public in 2014.

Leana Wen, M.D., author of "Who's My Doctor? The Total Transparency Manifesto," summed up physicians' attitude regarding the sunshine provision this way:
"Doctors need drug companies. We’re not influenced by them. They just pay for lunches, and I need to eat. Bedsides, it’s not my patients’ business what I do."

 Dr. Wen, however, believes that patients should know where their doctors get their money, especially if they are getting paid by drug companies and medical device companies.

"Dozens of studies have shown that even small gifts affect physicians’ prescribing habits," says Dr. Wen, "and that doctors suffer from the 'you but not me' phenomenon -- where we believe our own prescription habits aren’t affected (which implies that pharma is somehow wasting their marketing efforts, a contention we know is not true)" (see "To the Doctors: Why We Need to Be Transparent With Patients").

Dr. Wen is soliciting physicians to "endorse" her "Total Transparency Manifesto," which states in toto:
We are physicians who believe in total transparency with our patients.

When patients come to us, they are in a time of need. They are scared; they are vulnerable; they are in pain. Patients need to trust that doctors have their best interests at heart. They need to know who their doctor is.

All of us Transparent Doctors hold ourselves to be publicly accountable to our patients. With the disclosure and our Total Transparency Manifesto, we are saying that we don’t have anything to hide from you. We know patients are vulnerable; we will be vulnerable with you. This is a partnership. We are in this together.

Thank you for joining us on this journey to rebuild and transform our healthcare system to one that upholds professionalism, prioritizes patient values, respects human dignity.
To date, 11 physicians have endorsed the manifesto (see here).

Meanwhile, how do my readers -- pharma marketing professionals -- feel about gifts to physicians and bias?

My "Gifts to Physicians Survey" asked respondents: "In your opinion, to what degree may EACH of the following pharmaceutical industry gifts/subsidies/payments to physicians present a potential conflict of interest? Think of it this way: if you vote High Degree, you favor banning the practice; if you choose Very Low Degree, you favor continuing the practice as is." (Response ranges: High Degree of Conflict, Moderate Degree of Conflict, Neutral/Don't Know, Not Much Conflict, Very Low Degree of Conflict):
  • Free lunch delivered to office in exchange for sales presentation
  • Free drug samples
  • Pharma-supported CME (free to physicians)
  • Free meals away from the office
  • Payment for attendance at lectures and conferences
  • Payment for travel to meetings or scholarships to attend meetings
  • Payment for participation in speakers bureaus
  • Free provision of ghostwriting services
  • Grants for research projects
  • Payment for consulting relationships
The results are summarized in the following chart:

1 comment:

  1. I know very few, if any, companies that offer collaborating investigators and authors "ghostwriting services" for publication development. Professional medical writing services is more accurate, and acknowledgement of such services (writing, editorial, etc) should be made transparently per Good Publication Practice guidelines (currently GPP-2). Ghostwriting is unethical--no matter who pays for it.


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