Yesterday’s post provided a link to an article which questioned if physicians are “in the pocket” of pharmaceutical companies which produce opioid pain meds.
This is a complex issue which applies to oncology as well.
I must admit I have felt uncomfortable from time to time after learning that many of the top myeloma experts are paid by drug companies which manufacture the very drugs they prescribe as anti-myeloma therapies.
Think there is a conflict of interest when dealing with relatively inexpensive drugs like pain killers? How about deciding whether to prescribe a far more expensive chemotherapy drug like Revlimid–which according to my last statement–has a list price of $11,216 for 21 25 mg capsules.
Apparently the industry recognizes that there might be a problem. Check-out this article from the trade publication, Clinical Oncology News:
Money for Drugs: Should Physicians Be Paid for Pharmaceutical Development and Clinical Investigations?
The Cause of the Day for many pundits and academics is the terrible wrongness of physicians taking any sort of payment from pharmaceutical companies. Drug companies, otherwise known as Big Pharma, have been demonized by the media, academia and politicians. They make too much money; charge too much; market too aggressively. We’ve all heard the litany of complaints. But, are they really evil? Are we really wrong to interact with them?
We are having a national discussion over the propriety of physician relationships with industry. The tone of that discussion is hostile to both physicians and industry. The discussion is being largely conducted within medical journals, which themselves are partly supported by drug company advertising, and reported by news media that also profit from commercial advertising. Two of the most popular books on the subject were written by former editors of a journal that accepts drug advertising, and charges a lot for it.1,2 Should we have different ethical standards for medical journals than we do for individuals? Perhaps so. But that argument is not being made. There is a whiff of hypocrisy about the whole discussion.
It would be well to define some common assumptions. First, physicians can, and should, be paid for their time. The ethical position that physicians should work for nothing may be valid, but it pretty much closes off this discussion. Second, it is unethical for physicians to sell their opinions to the highest bidder. We should not go out and urge other physicians to use a given product simply because we are paid to do so.
This is, contrary to what many believe, a complex issue. To begin, is it ethical to work on drug development and clinical investigation? Most of us would say yes. How can it be otherwise? If physicians cannot ethically be paid to develop and test new drugs, then who is to carry out this vital work? Non-physicians? Employees of the drug companies? Congress and the media?
Suppose a physician serves on an advisory panel for, let us say, the development of a new cardiac drug. That involves time and travel, perhaps other expenses. If physicians cannot participate, I ask again: Who is going to do it? It is in society’s interest that the best clinicians advise the companies. Can it seriously be claimed that the companies should develop drugs without input from physician clinicians?
Most drug studies are funded by contracts with institutions, although some are with individual physicians or groups. Does it make an ethical difference whether the money goes directly to a physician or indirectly through the salary from a university? Surely not. Otherwise, anything could be justified by simply laundering the money through some convenient institution. One may argue that certain institutions, like universities and hospitals, have such high ethical standards that it is inconceivable that they are influenced by mere money. One may argue that, but one is unlikely to be believed…
You can read the second half of this thought provoking article by CLICKING HERE.
After you finish reading Dr. Van Way’s point of view, you will be pleased to find an opposing view, written by Dr. George Bohogian, about the same issue:
No, Physicians Must Remain Independent of Pharma
Read both points of view and let me know what you think.
I am more than appreciative of the myeloma experts and other medical professionals who have helped keep me alive longer than I have had a right to expect.
But like a lot of other things in life, this conflict of issue conundrum can look pretty messy if you start to examine it closely.
Tomorrow we will return to a less theoretical and more practical topic: Danny Parker’s next column about diet and multiple myeloma.
See you then! Feel good and keep smiling! Pat