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

Modern Healthcare - - Front Page -

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

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