Monday, October 04, 2010


One of the new features in many American medical meetings ( present in AHA 2009, ACC 2010, and TCT 2010, is a discussion of new health regulations governing relationships between medical industries and physicians. In spring 2010, the Obama administration, passed through the US Congress something called the Physicians Payments Sunshine Act. Amongst all the tiny details, it, and I quote, " requires yearly reporting by manufacturers of drugs, devices, and biological and medical supplies of all payments to physicians or physician-owned organizations over a cumulative value of $100. Under the act, these reports would be then made available to the public ".
This has become the topic for discussions at medical meetings, the last was at the just concluded TCT 2010. It is of particular importance because TCT is where industry show-pieces their latest devices and products to get market awareness. We all know that key physicians are always approached to develop new ideas, and innovate. Sometimes the ideas come from the physician and the industry is sold the idea and they help develop. Many devices, including stents came this way. Physicians buy stocks is these companies, before the breakthrough device is announced and so make " tons" of money when the share rises. In the pharma industry, some physicians ( the big guns " are paid to speak at meetings about certain products and in a way become a marketing agent for the drugs. They are paid hefty fees for that. Some " famous physicians " are paid to write good articles in famous journal to influence practice patterns. Sometimes clinical trials are reported in such away as to help certain drugs. We have also heard, last year of " ghost writers ". These are some famous physicians, who never took part in the clinical trial, but write findings for famous journals so as to influence practice patterns. All these practices, I am sure are unethical and lead us to be wrongly influenced in our choice of therapy, be it drugs or devices.
Of course, in Malaysia too, we have some of the above. We do not yet ( to the best of my knowledge ) have innovators who invented devices which has greatly impacted on clinical practice internationally. I do not think that we have " ghost writers ". We do have physicians, paid by pharmas to speak good about their products. We do have physicians, particularly in government service, who have pharma paid holidays, so that they can " put in a good word " to the relevant authorities, to influence the inclusion of certain drugs from certain companies, into the government " blue book ". The " blue book " has items that the government purchase for use in public healthcare facilities. The government is the largest single purchaser of drugs in this country and if your product ( drug or devices or prosthesis ), get into the blue book, you are assured of alot of sales for the period of the contract. So companies will " take care " of key government senior physicians well ( almost at their back and call ) so that their product can get into the " blue book ". I have seen how they " take care" of these doctors. Believe me, the companies are prepared to spend big.
In a more controversial way, is the present system of organising CMEs ( continual medical education ) meetings for doctors. Doctors who graduated in 1995, will need to be refreshed and updated. Being very stingy people ( they certainly are not poor, but have just got use to free lunches ), they would not pay, to attend CMEs to update. They will only attend if the medical meetings are free ( sponsored ), and if possible with door gifts and leather bags, before they will consider attending. If the meetings charge a fee, the doctors will ( shamelessly ) ask the pharmas to pay for them. Such is our legacy. So we have always depended on pharmas and device companies ( the industry ), for our continual education.
I have laboured the points enough. The US authorities are beginning to take action. What then is the solution for us?
I organise two big CMEs annually, with sponsorship from the industry. I have discussed these issues with the organising committee.
One of our strategy is to raise sponsorship money, from all the competing pharmas and device companies, into a common pool, under the treasurer-ship of a registered medical association, and have the organising committee draw up the scientific program for the meeting. We were hoping that by so doing, we can avoid, in large part, " conflict of interest issues ". All the therapies ( drugs and devices " will be discussed openly, pertaining to the treatment of the certain condition, and leave it to the expert physician to follow clinical trial results and guidelines in their presentation. This has worked well for us, and by and large, the meetings so far have been very successful. But of course, pharmas will only sponsor " small money " if they have no exclusivity. They will be prepared to pay more for sponsorship, if their product is highlighted. So we have to operate with tight budgets.
In the US nowadays, all presenters at meetings, must begin their talk by declaring their conflict of interest statements. I have seen many of my rich and famous colleagues " hide " their conflicts in vague statements.
Is the Obama administrations " Physicians Payments Sunshine Act " the solution? Will it hamper innovations? Locally, will CMEs be able to be conducted without industry help. Not to forget that anything above USD 100 have to be declared and there is not much that you can do for less then USD 100. There are more and more physician organisation being formed annually ( so many experts around ), and they all wish to have their expert conferences. What to do? What is the solution.
I suppose the MACC ( locally ), can begin by looking into these senior physicians who are very " cushy / pally " with industry. Maybe that would be a good first step. Then that riases the whole issue of MACC and their partiality or impartiality?
Looks like doctors, can we stick to being just doctors?

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