Pain Medicine Rocked by Perception of Conflicts

Controversy around payments to physicians from companies that make pharmaceuticals and medical devices has been much in the news lately, especially related to pain medicine.

ProPublica reported on deep ties between two physician leaders in pain treatment and the pharmaceutical industry. A nifty page created by ProPublica lets viewers search for their physician’s name in the database of payments reported by industry.

The Milwaukee-Wisconsin Journal Sentinel reported that the steep increase in use of pain medications in recent years is paralleled – and their headline says “fueled” – by a network of physicians, researchers and organizations pushing for greater access to narcotics while taking money from drug companies. They published a nifty graphic and a case study to help make the case.

Most recently, the New Haven (Conn.) Independent reported that a dozen doctors in the state continued to receive money or gifts from drug companies while being sanctioned by the state for prescription-related offenses.

Dr. Jerome Schofferman (SHERRY BOSCHERT/IMNG Medical Media)

At the annual meeting of the American Academy of Pain Medicine, I asked one of the speakers at a session on ethics to comment on all this. Dr. Jerome Schofferman said he is not a trained bioethicist but he follows ethics with a passion. How passionate is he? Dr. Schofferman refused to wear the lanyard that all attendees received in their registration package because it had a company’s name on it. (A lanyard is the ribbon that clips onto the name badge, to be worn around the neck.) He brought his own lanyard.

Part of the problem, he said, is that drug companies develop a lot of “me-too” drugs that work like other available drugs, then avoid doing head-to-head comparisons so that no one can say their drug isn’t as good as another, and pour their resources into marketing their drug to boost sales.

“There’s no doubt that these drugs are overmarketed and probably overprescribed, but they work for a lot of people,” so we need to keep the potential benefits in mind in all of this too, he said.

Relationships between industry and physicians or patient advocacy organizations can be a mutually beneficial thing and aren’t inherently bad, but the lack of full and up-front disclosure of the relationships gives the impression that something’s not right and prevents people from making informed judgements, he said.

In the articles on industry and pain medicine, “No one has ever really shown in this context that this is bad. It’s just the perception is that it can’t be good. It can be good if the American Pain Foundation accomplishes a lot of good things,” Dr. Schofferman said. Too many groups and physicians hide their industry connections instead of making them easy to find. “If there had always been disclosure at the top of their Web site or their publications, a lot of this wouldn’t come up. It wouldn’t be a story, and it wouldn’t have that oomph factor,” he added.

In his talk at the meeting, though, Dr. Schofferman was a bit stricter than in our interview, arguing that disclosures alone are not enough.

He cited an article by social scientists suggesting that 61% of physicians say that conflicts of interest do not influence their decisions, but 84% of physicians admit that conflicts of interest might compromise other physicians (JAMA 2003;290:252-255). Bias and influence are neurobiological social processes that can alter behavior in unconscious ways, he explained. People may want and choose to behave ethically but still be influenced by economic factors because human nature inherently reverts to reciprocity and self-interest, functional MRI studies suggest.

Dr. Schofferman suggested several ways to personally minimize industry influence:

Dr. Jerome Schofferman (SHERRY BOSCHERT/IMNG Medical Media)

1) Don’t be in a company’s speakers bureau. These are “marketing by proxy,” he said.

2) Don’t attend industry-sponsored satellite sessions or marketing dinners at meetings. Get your medical education from accredited sources.

3) If you’re an educator, divorce yourself from industry, or at least provide full disclosure including dollar amounts of anything you receive.

4) Don’t be an industry “advisor” or “consultant” unless you truly are a thought leader and innovator with specialized skills, knowledge, or experience that you bring to the relationship. Spell out that relationship in a written contract describing details of the work product to be delivered and a timeline for delivery. Charge only fair market value for your time and expertise.

5) If you are an industry speaker, advisor or consultant, do not seek leadership positions in professional medical associations.

6) Professional medical organizations and conferences should limit industry participation to ads in journals and to exhibit halls (“But don’t put food in there!”), and stop splashing corporate logos on everything, such as lanyards. “We’re like NASCAR drivers” at these meetings, Dr. Schofferman complained.

Starting in September 2013, industry payments and gifts to physicians will be posted online under the Physician Payment Sunshine Act.

–Sherry Boschert (@sherryboschert on Twitter)

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Filed under Drug And Device Safety, Family Medicine, IMNG, Internal Medicine, Uncategorized

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