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Doctors And Drug Companies: The Other Side Of The Story

Tuesday, July 19, 2011


I wanted to take this opportunity to respond to the article published on GoLocalProv.com dated 7/18/2011: Cashing In: RI Doctors Paid Millions by Pharmaceutical Companies. It is my hope that by presenting more of a factual basis rather than just listing sensational headlines and fees paid to Doctors that there will be more substance to the issue which may enlighten rather than misinform your readers. Just as a quick background I am a practicing physician in North Dartmouth MA and have been for 20 years. I also head one of the preeminent asthma and allergy research sites in the US and have been working with the research arm of pharmaceutical companies developing many if not all of the current drugs for those indications in our specialty for that same period of time. We pride ourselves on our work, reputation, ethics and the service we provide to both our patients in the clinical and research aspects of our practice, so I believe my background can certainly shed light on this topic

The overall concern I have with your article was how skewed it was in painting physicians in a terrible light. By using a sensational headline and devoting more of the article space to listing dollar amounts rather than inquiring what those amounts were for, you do a disservice to the piece as well as the medical and pharmaceutical professionals. While this topic is complicated to say the least and one could write a dissertation on it, I will try to stick to the facts and attempt to counter some of the myths that prevail both in the media and the public forums.

Drug Companies Mean Well

As a group physicians are ethical professionals who put their patient’s interest first. This is embodied by the Hippocratic Oath administered to every graduating physician which means “Do No Harm”. In today’s complicated arena it is the physician who is the last bastion of hope for patients acting as their advocate when outside forces predominately the government and insurance companies show little regard for the patient and treat them more as a number and statistic. I believe the same standards also apply to the vast majority of Pharmaceutical companies.

The Pharmaceutical companies despite being vilified ad nauseum in the press and by special interest groups has provided a vast array of treatments which improve health and will continue to do so. While they are regarded as a business very few laypersons know of the costs and procedures involved in getting a drug through the FDA and to market. Most for example do not realize that for every drug approved 10 do not make it. And at what cost. Most profits are poured back into research and development to find newer and more effective treatments. Stifling innovation in this industry will eliminate many of the treatments for the future. Just look at the success rates for the treatment of childhood leukemia as one example and the success rates with research on new therapies. Most don’t understand that the patent life for drugs starts at the initial filing of the drug and companies may only have a few years before generic companies come in and profit from the initial work. Reforming patent laws to make them more reasonable would be helpful to say the least. I did say the topic was complicated

Know The Facts

Let me digress and return to the issue at hand, the interactions with physicians and drug companies. I will start of by answering a question. Were there in the past activities by pharmaceutical companies marketing departments that could have been perceived as crossing the line. The simple answer is YES. Did they involve all activities of those companies the answer is NO. It has been several years since the industry has implemented a code of conduct to regulate the interactions between physicians and the industry (can’t say that for your elected representatives can you?). This code of conduct clearly spells out what is accepted and what is not. For those that believe Doctors receive monies or trips or gifts based on their prescribing habits then you are misinformed and do not know the facts. Many of those who harbor conspiracy theories in facts somehow forget the current code of conduct which has been in place for some time. They often miss the real issue which influences prescribing habits more than anything else.

In most cases it is the insurance companies who dictate to physicians what they can and cannot prescribe by having restrictive drug formularies and excessive co- pays for certain medications thus eliminating through force and economics what patients can receive (remember what I said the consequences would be when you lose your physician advocate). So now we have a system in which the pendulum has swung the opposite way and has regulated in some cases to the extreme by eliminating the interactions between physicians and the pharmaceutical industry.

Medicine More Complicated Than Ever

In many cases having lunch or coffee with an industry representative is deemed a crime. I have in fact been at national conventions where a cup of coffee was denied because my state of Massachusetts has implemented draconian regulations against the physicians industry interactions. Please give me and my respected colleagues more credit. My prescriptions cannot be bought for a cup of coffee, but that is what many would like you to believe. So what is the current state of interactions between the pharmaceutical industry and physicians? The majority of interactions now are that of Continuing Medical Education or as we say CME’s.

Medicine more now than ever is more complicated than ever with most physicians being unable to keep up with all of the new information in their respective fields. Add in the hassle factor from the government to insurance companies and you wonder how physicians can operate within a twenty four hour day and still have a life. Many physicians get valuable information on disease states and current treatments from these talks. In fact the code of conduct specifically states that speakers are not to discuss specific brands for treatment especially that of the sponsoring company in order to eliminate a conflict of interest. I bring this up to point out that I am sure the vast majority of those physicians listed in the article received honoraria as a speaker or consultant for the industry.

Many could have also brought their expertise in their field to discussions with companies about developing new treatment guidelines or drugs, or educating physicians about the current state of specific diseases for which they are entitled to be compensated. Who of you would spend time out of your job or in the evenings working without getting paid? Last time I checked if I need something from my plumber lawyer or anyone else I require their services it usually involves paying them for that service. This was one of the issues I had with the article …. you printed the compensation but have no knowledge of what services were rendered. It certainly was not “kickback” dollars for prescribing specific medications.

So as you can see the topic is quite complicated but the core issue is to what extent pharmaceutical companies exert their influence on physicians and their prescribing habits. The answer is very little if any. The days of the office pens pad and trips are long gone and have been for quite some time.

We Work Hard

New regulations are in place which police the physician to industry interactions. To some extent this has been taken to the extreme. Legislation in MA passed a few years ago has had an impact on the economy to the point where the Governor/Legislators have talked about its repeal.

No one is arguing against full disclosure in fact it is the right thing to do. What is not right is to take numbers without explaining the services rendered and paint a broad stroke by portraying doctors as the agents of the pharmaceutical industry. As a group we are ethical hard working committed professionals who care about every aspect of our patients. The best words apply today as they did in the times of Hippocrates….”Do No Harm.”

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Andrew Dzykewicz

Interesting apologetic, but nowhere in the article do I see an explanation of the purpose for payments in some cases exceeding $60,000 in a single year.

Dr. Miller - What is the legitimate purpose?

Henry D

I thought you made some very good counter points here. There is always 2 sides to a story and sometimes 3. I think you are correct Dr. Miller in pointing out there are times the compensation is well earned and doctors do work very hard to do a good job. The author of the first article could have done a little more fact finding to discover what the compensation was for, rather than painting broad brush strokes.

Tammie Acosta

Without the initial story calling out all the doctors, there wouldn't have been a need for Dr. Miller to respond with this "side" of the story. Atleast golocal published both sides unlike many other news networks.

QQ! - cookie for those who know what that means.

David Bibeault

Dr Miller is correct that in the past there were abuses in the relationship between Doctors and Pharmaceutical companies. Today, those abuses are very few and far between but that doesn't stop bureaucrats looking for a problem to solve. In usual fashion, the bureaucrats have gone way overboard and actually have made the situation worse for patients. Drug companies paying for seminars and CE's (Continuing Education required to keep your license) help to keep health care professionals up to date on the latest advances in medicine which change daily. I recently attended an all-day Oncology seminar in Boston which I found very valuable. The company representatives felt that bureaucratic rules just limit health professionals access to the latest information and that would harm patients in the long run. Do you really think a Doctor, Nurse or Pharmacist would do something that wasn't in the best interest of their patients because they were given a steak dinner or a pen or pad with a drug name on it? I think it's ridicules that Politicians insist that a dinner would affect a health professional's judgement yet these are the same people that take millions of dollars in campaign contributions from special interest groups and insist that it doesn't affect their judgement.
Finally, I'd also like to address the chronic bashing that drug companies are subjected to by politicians and the media. Ironically, most of the people doing the complaining would be dead if it wasn't for the advances made by these drug companies. It is a very expensive and risky business to be in. As Dr. Miller stated, only 1 in 10 drugs actually makes it to the market. Add billions of dollars spent on research to the $200 million fee the FDA charges for a new drug applications (thanks to Bill Clinton) and don't forget all the frivilous lawsuits and people wonder why drugs are expensive? Hmmmm, I can't use a Cipro pen but politicians can take millions from lawyers...

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