September 4, 2008

Doctors May Only Be Paid Once



The ACCME (the people who run CMEs) are asking doctors to comment on their proposal, which is:

Persons paid to create, or present, promotional materialson behalf of commercial interests cannot control the content of accredited continuing medical education on that same content.
In other words, if you're a doctor that is on Abbott's speaker's bureau for Depakote, you would not be allowed to present CME lectures on Depakote's use in bipolar, because even though CMEs are technically free of Pharma influence, you may have a bias because of your prior financial entanglements.

How could anyone be against this proposal?

Here goes...




The logic is important and deceptive.  They aren't implying that in order to keep Abbott happy, you'll lie during a CME lecture and say Depakote is more awesome than it is.

They are saying that the bias is deeper, that because Abbott pays you so much, you're going to actually believe Depakote is awesome, and you'll say that during a CME.  People will think you're being all scientific, they won't realize that the reason you believe it is because you were paid so much, so often, that you now do believe it.

So the two have to be separated.  To keep CMEs pure, speakers can't have been paid by Pharma on a similar topic.

Ok, I have a question: if we do this, why would anyone, ever, choose to do CME lectures over a Pharma talk? 

Before you freak out "not all doctors can be bought!" follow the logic here.

You aren't lying-- you actually believe Depakote is awesome.   If you actually believe Depakote is awesome, why wouldn't you only speak for Abbott and never do CMEs?  You're being honest, you're saying what you think, what do you care if people are slightly suspiscious because the dinner is sponosred by Abbott?  You're telling them what you know to be true.

Take it a step further: what if you believe Depakote is awesome based on science, or your own judgment?  And had never been paid by Pharma before?

Then you see, the result of this inanity is that anyone who believes, for any reason, Depakote is awesome will have to choose between giving a few CMEs a year for less money, or lots of Pharma programs for more money.

I observe that there's no prohibition on receiveing NIH money and giving CMEs, because obviously there are no biases at the NIH.

Look, people, if you want to completely ban doctors from ever doing Pharma programs, then let's take the debate there and decide.   But if you cannot construct a solid argument for this abolition, then all of this back door, smoke and mirrors protectionism will always follow the law of unintended consequences.

(Another post  on the separation of church and state.)








Comments

Then you see, t... (Below threshold)

September 5, 2008 5:29 AM | Posted by Brooks: | Reply

Then you see, the result of this inanity is that anyone who believes, for any reason, Depakote is awesome will have to choose between giving a few CMEs a year for less money, or lots of Pharma programs for more money.

So what's the harm in that? Sure, some doctors who believe Depakote is awesome will no longer have income from their practice, CME's, *and* Pharma programs. And, with the weak dollar, that may mean only two Porsche's and a single Mercedes for those poor folk.

What you've got here is a classic means-justify-the-ends argument. Because *some* doctors can take gobs of Pharma money and remain uncorrupted, and because *some* doctors who cheerlead for particular medications would do so without Pharama money, therefore *all* doctors should be able to receive financial assistance from Pharma with the expectation that it won't color their views.

Look, I'm a small-l libertarian myself. I instinctively dislike regulation, and I like the free market. But you're arguing for loopholes and technicalities based on the (true) assertion that not everyone who gets paid because they hold a particular view does so because of the payment. As someone who hopefully studies human nature and understands the role of incentive in psychology, you *have* to know better than that.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
I have put your blog on my ... (Below threshold)

September 5, 2008 9:11 AM | Posted by unkommon sense: | Reply

I have put your blog on my reader cause I like the way you think. Even when I do or dont agree with you

Anyway I want people to stop thinking that the medicine industry does not work like every other industry in a captialistic society. The vendor/client relationship is crucial to product development and marketing.

Academics arent saying the research or what information drug reps are bringing to doctors are wrong. They just want to be the ones who tell you. And I am sick of the pious tone they want to take against a very intergral part of our system.

We are in this debate because in the past there were serious abuses of this relationship. Paying docs to enroll patients in studies, kick backs for prescribing etc. But now we have over corrected the problem by saying NO commercials. Seriously a pen is not a roundtrip ticket to Hawaii. A dinner talk on HOW THE DRUG WORKS is not a payment for prescribing it.

The only way to change this is to change our system model and make medicine more like a socialized system, but that has it pitfall to because then the government would get to tell doctors how to practice, well right now hmo's do which is a topic for another post.

check me out at www.nokommonsense.blogspot.com

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Pharma will just create the... (Below threshold)

September 5, 2008 9:31 AM | Posted by MedsVsTherapy: | Reply

Pharma will just create these other entities, like the North American Menopause Society, or Michael Phelp's mom's group, "ADHD Moms, and sponsor CME docs through them. Wise to note the law of unintended consequences here.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
"Seriously a pen is not a r... (Below threshold)

September 5, 2008 10:09 AM | Posted by quick: | Reply

"Seriously a pen is not a roundtrip ticket to Hawaii. A dinner talk on HOW THE DRUG WORKS is not a payment for prescribing it."

There is data on the results of a pen or a dinner. You may want to look into that.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
There is data suggesting co... (Below threshold)

September 5, 2008 12:27 PM | Posted, in reply to quick's comment, by nokommonsense.com: | Reply

There is data suggesting commercials work? Big revalation. NOT. Nobody points out the bias in these so called studies. Like doctors paid $20 to complete on survey used in NEJM study and the inherent answer bias or "lead bias" in asking a question "Pharm reps influence your doctors. Agree disagree etc".

I am not a great fan of pure capitalism, trust me. But what are these studies suggesting that people are wrong to try new drugs when they come to market a study isnt complete until phase IV (aftermarket research is conducted that cant be done until people have tried the meds. That the research is flawed or biased in industry? So what it is in academia I did bench work and believe me you fudge data their to get your grants through.

My point is that we are really over correcting some very real abuses of the pharm/doctor - vendor/client relationship. I am smart enough to realize a commercial when I see it.

One last point about medicine being an industry. When you buy a car you dont think brake makers or other vendors cator to automakers. Their industry affects peoples lives almost as directly as we do, but nobody gets upset if they se a NAPA poster at the Toyota dealership.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
"I am smart enough to real... (Below threshold)

September 5, 2008 1:40 PM | Posted by quick: | Reply

"I am smart enough to realize a commercial when I see it. "

Of course you are.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
I am thank you for acknowle... (Below threshold)

September 5, 2008 4:44 PM | Posted, in reply to quick's comment, by nokommonsense: | Reply

I am thank you for acknowledging it. oh wait that was sarcasm! Damn, sorry I'm much better at recognizing comercials than sarcasm.

Vote up Vote down Report this comment Score: 0 (0 votes cast)
Wishing you the best... (Below threshold)

July 1, 2011 4:43 AM | Posted by Gucci Outlet: | Reply


Wishing you the best of luck for all your blogging efforts.

Gucci Outlet

Vote up Vote down Report this comment Score: 0 (0 votes cast)

Post a Comment


Live Comment Preview

October 25, 2014 12:44 PM | Posted by Anonymous: