Financial Ties

A Boston Globe editorial is arguing for “full and accurate disclosure of potential conflicts that accepting drug company consulting and speaking fees could pose.” The op-ed is written in response to the recent discovery that psychiatrist Joseph Biederman of Harvard and others had failed to disclose consulting fees and other finances received from pharma companies — an error (whether by omission or commission) that violates Harvard’s conflict of interest policies and has caught the eye of Senator Grassley (R – Iowa).

Conflict of interest and pharma/physician relationships are of particular interest to Grassley these days, and he’s triggered several congressional investigations into the matter. The Wall St. Journal health blog also covered the issue of Biederman and his colleagues collecting consulting and speaker fees from pharma, and they linked to the Furious Seasons blog, which in turn linked to this list of Biederman’s currently open clinical trials.

Here’s where I have an issue — and it’s not at all that I would defend Biederman et al. (I don’t necessarily agree with their line of research, and I certainly don’t agree with their lack of disclosure and questionable claims of innocent omission on their part). In the world of pharma dollars, research, speaking fees, medical education, and clinical trials, not all dollars are the same, and it’s not necessarily the money that is causing the potential conflict.

Clinical trial dollars, even for principal investigators, should not be viewed in the same light as pharma money that is provided for consulting and advisory panels. Likewise, pharma educational grant money is different. In the case of clinical trial and research dollars, PIs sometimes see very little of that funding, as it goes to their home institution, which may or may not consider clinical research funding as part of the physician’s incentive plan.

Money that physicians receive as speakers in CME programs is also different — while a pharma company may financially sponsor an educational program, there are already strict rules about program independence from industry, disclosure of potential conflict, and balance/lack of bias for educational speakers.

Research and education activities can certainly influence a physician’s perspective and introduce bias, but dollar amounts do not necessarily equate to a pharma company purchasing a physician’s influence. Even buying physicians lunch or handing out pens can change doctors’ prescribing habits. Should everyone in health care be forced to disclose how many free pens/flash sticks/mugs they received from pharma last year?

The dollar thresholds established by many universities and academic medical centers are rather arbitrary ($5,000; $10,000; $15,000) and actually might not have much sway over a physician who makes more than a million dollars in a year. I would argue that many more physicians are swayed (whether they realize it or not) by the prestige and perks bestowed upon them as a result of being a big gun in research and a popular speaker. While pharma may fund these opportunities, the truth is that no other entity is willing to provide the financial backing for clinical research or medical education. Our broken health care system needs pharma industry money to conduct research, develop new clinical approaches and technologies, and educate physicians and the health care workforce. Pharma needs hospitals and their top docs to conduct research, develop new clinical approaches and technologies, and educate physicians and the health care workforce. The relationship might be unfortunate and open the door for a host of conflicts, but it’s also inevitable in the current environment.