Motivation behind physician advisotry boards
Physician participation on advisory boards can offer real benefits, but it’s also fraught with perils that might not be worth the risk
About 10 years ago, a wellknown pharmaceutical firm asked Dr. Daniel Carlat to serve on a medical advisory board.
This was before the ongoing national explosion of medicalethics crises, and Carlat at the time was known for working closely with industry. Carlat says he didn’t shy away from the chance to go to a nice hotel and answer some questions that would help improve cutting-edge pharmaceutical therapies.
But when he and the other 10 or so psychiatrists arrived at the meeting, Carlat says the company rep handed the doctors copies of proposed promotional materials and simply asked about “our impressions of the material, and how believable it was.”
He quickly saw this was not about making better drugs, but rather marketing—and it wasn’t clear to him whether the audience that the drugmaker intended to influence was pharmaceutical consumers or actually him personally. “One of the questions that comes up is, is there always a hidden agenda?” Carlat says.
“Is the agenda to market to that specific physician?” he says. “That’s something that would be very hard to get any drug company to admit to, but it’s widely acknowledged that that is a large part of why they do these things.”
Recalling the experience in an interview this month, Carlat says the incident was among many that led him to renounce industry contacts, including medical advisory boards, as too ethically troublesome to be worth their while. His skepticism about collusion with the drug industry also fuels parts of his new book, Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis.
Officials with the industry association Pharmaceutical Research and Manufacturers of America declined to comment and referred questions about medical advisory boards to the ethics section of its website, which was updated in 2009 in the wake of national scrutiny of whether industry money was affecting physicians’ independent medical judgment.
The 2009 update to the voluntary Code on Interactions with Healthcare Professionals, now endorsed by 55 pharmaceutical companies, includes strict limits on how the drugmakers can reimburse doctors for their advice.
For example, the code says it is reasonable to pay physicians to consult on such boards, but only if the mission of the board is defined to address a specific problem and the fees paid are “reasonable and at fair market value for the services provided.” PhRMA’s code prohibits holding advisory board meetings at posh resorts and paying for spouse travel or entertainment.
Experts say that sometimes advisers on such boards are treated as highly compensated consultants, while others are paid a nominal stipend plus travel expenses to a meeting location once or several times a year.
AdvaMed, an association that represents medical devicemakers, also revised its code of ethics for interactions with physicians in 2009, classifying medical advisory boards as consulting arrangements.
AdvaMed General Counsel Christopher White says industry officials view consulting collaborations with physicians as essential to the development of better devices and therapies, not an inducement to steer physicians toward particular products.
“Our view is that the physicians are highly skilled, highly educated individuals who deliver patient care in a manner that best fits with patient needs and preferences,” White says. Consulting “agreements are constructed to carefully ensure that they don’t alter the physicians’ focus on the best interest on the patient.”
Dr. Sidney Wolfe, an internist and longtime director of the not-for-profit Public Citizen’s Health Research Group, says no ethics code or any amount of public disclosure can cure the problems that happen when a doctor receives payments from a healthcare-supply maker.
Rather, Wolfe says a doctor would have to be in “utmost deepest denial” to think such payments did not influence their decision-making.
“They do not think it impacts their thinking. Obviously, the drug companies do, or they wouldn’t pay the doctors for it,” Wolfe says. “It is a massive conflict, and the thinking of these doctors cannot help but be affected by being on these advisory committees and getting paid for it.”
The New York-based independent investigative journalism organization ProPublica has compiled a database called “Dollars for Docs” showing that eight large pharmaceutical companies disclosed direct payments of $320 million to physicians in 2009. That figure, which is the most recent data available, represents about