Monday, October 5, 2009

Will younger doctors be more resistant to drug company blandishments?

A week or so ago, I gave a talk to about 120 senior citizens at Brandeis University's Lifelong Learning Institute. The crowd was largely receptive to the topic -- how American consumers have been routinely misled about the safety and effectiveness of new drugs and treatments. They asked intelligent questions, and one retired psychiatrist even stood up to say how much he regretted having taken money from a drug company -- in the form of a free junket to a tropical locale -- to hear speeches about how wonderful its SSRI antidepressant was. He wouldn't do that now, he said, and he was sorry he had done it then.

But there were at least two people in the audience who didn't like what I had to say at all. In my talk, I had suggested a number of needed reforms, including passage of the Physician Payment Sunshine Act, which I've blogged about here. I even suggested that until that bill is passed, consumers might ask their doctors if they are getting any payments from drug companies that could possibly skew their prescribing habits.

During the Q&A, one man, who said he was a retired doctor, said that if a patient of his ever asked a question like that, he or she would be shown the door. Another doctor, a retired ob-gyn, took issue with what I'd said about the industry's longstanding practice of misleading consumers about new drugs, going back to the hype over hormone replacement therapy (HRT) on up to the current aggressive promotion of cervical vaccines like Gardasil. He accused me of exaggerating the dangers of HRT and practicing "sensationalistic journalism."

Rather than engage in verbal fisticuffs. I merely cited the recent studies showing that HRT increases the risk of breast cancer in women and repeated my concern that parents of young girls now targeted for the Gardasil vaccine in this country and Cervarix in the UK may not be getting the full story about the risks and benefits of these vaccines in treating cervical cancer. (For more on this issue, read Schwitzer health news and Gooznews).

But what struck me (and others in the audience) was the inability of these two doctors to understand that the winds of change are blowing and that the way they once practiced medicine -- with absolute deference from patients who viewed them as gods -- is a thing of the past. Consumers are waking up to the fact that doctors are human and thus susceptible to the same human frailties that tempt all of us. Money talks and can taint a doctor's judgement as much as it can anyone else's.

This was a major theme of Side Effects, and in the talks I've given since the book came out, I have stressed the need for full disclosure of financial conflicts and called for a ban on researchers receiving consulting and speaking fees from drug companies. Which is why it was so good to see the editorial in The Boston Globe last Thursday calling for much the same reforms. (The editorial followed an excellent article by Liz Kowalczyk earlier in the week).

Change is never easy. But I'd like to think that the newer generation of doctors are more savvy about the ways in which drug makers try to influence their judgement -- and a little more understanding of their patients' desire for transparency.


Mr. B. said...

During the Q&A, one man, who said he was a retired doctor, said that if a patient of his ever asked a question like that, he or she would be shown the door.

And for an increasing number of patients, they may head for the door also if treated this way, AND complain to the clinic where treated.

It is a good thing this guy is retired.

marginalutility said...

Wouldn't younger doctors be more tempted by the kickbacks, having less of a financial base to fall back on?
I feel queasy b/c I was so easily targeted and caught hook line and sinker by the Gardasil hype.

Michael Kirsch, M.D. said...

Of course, physicians should disclose conflicts that a reasonable patient is entitled to know. I do not think that patients want or need to know about drug logos that might be on a pen or a pad of paper. There are risks to pursuing extreme disclosure. See In addition, the financial disclosures that are routinely made by conference speakers and journal authors are so commonplace that they no longer have an impact.

mary weiss said...

"Will younger doctors be more resistant..." Probably not. But the question goes back further to the FDA. The NYTimes 9/25 told how four New Jersey legislators strong-armed the FDA to approve Menaflex, a patch for injured knees that research showed to be no better than routine surgery.
Then there's the two new psychotropic drugs: Saphris (asenapine) by Schering-Plough,approved August August 14, 2009, whose main side effect is akathisia. Google what Dr. Joseph Glenmullen of Harvard has to say about akathisia: not just restless leg syndrome, but can cause "anxiety, hostility, paranoia, rage reactions, violence." Akathisia caused my son to commit a violent suicide while taking the antipsychotic drug Seroquel.

The other new one isFanapt (iloperidone) by Vanda Pharmaceuticals. The FDA sent a 'non-approval letter' July 25, 2008 stating further safety studies were needed. None were done. Fanapt was approved May 6, 2009.

If the FDA can be strong-armed to approve a medical device, can this also happen with drugs? Of course.

These drugs should all come with the caveat emptor: Swallower Beware!

Mary Weiss, M.O.D.

Michael Kirsch, M.D. said...

Mary, I read the Times piece on Menaflex also, very disturbing. One thing that has become more obvious with health reform is how agressive the stakeholders are to protect their interests. Sometimes, their interests coincide with the public interest, and sometimes they don't.

Unknown said...

I work in the industry for a company that recently changed their practice when it comes to 'perks' for physicians. What fascinates me is the sense of anger in the physician community when we refuse to pick up the tabs for things that used to be customary. The company is responding to ethical concerns, but a surprising number of physicians are annoyed.

Michael S. Thomas

Michael Kirsch, M.D. said...

MIchael, We're not angry. I just think this issue has become OperationOVERKILL. It's silly to posit that a pen with a drug company name on it is corrupting. Let's root out real conflicts, not the imaginary ones. I'm sure you're aware of a 6 yr old kid suspended from school for 45 days a wk ago for having a scout-type camping 'knife' with spoon & fork. This draconian penalty was rescinded. Zero tolerance can lead to absurd outcomes.