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Is Your Endocrinologist "Under the Influence?"

Conflicts of Interest With Drug Companies and Physicians

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Updated May 07, 2007

Is Your Endocrinologist
In more than a decade as a patient advocate, it’s no secret that I’ve made a few enemies when I’ve questioned whether the close relationship between drug companies and our doctors is in the best interest of thyroid patients.

The sidebar to the right lists just a few of the many articles I’ve written in the past decade that call attention to the influence that thyroid drug companies, and especially Synthroid -- the top-selling thyroid drug, and one of the top 15 most prescribed drugs in America, according to RxList.com -- have had on thyroid doctors, their professional organizations, and even the doctors who run the various thyroid patient groups.

Here at the site, I recently linked to the program for the 2007 Endocrine Society conference –- the conference is known as Endo 07 -- and mentioned that the conference was offering a number of thyroid-related educational sessions to endocrinologists. My blog post pointed out the apparent irony of one session, titled “Thyroid Hormone Therapy: Why Some Patients Are Unhappy," and the fact that it is being sponsored by Abbott Laboratories, the manufacturer of Synthroid. The session is being led by Dr. David Cooper, an endocrinologist who has had long-standing financial ties to Synthroid’s manufacturer.

Interestingly, this particular blog post drew fire not from Cooper, but rather, from University of Kentucky professor and physician Dr. Kenneth Ain, who is also a medical advisor to the Thyroid Cancer Survivors’ Association (ThyCa). Dr. Ain is leading a thyroid cancer session at Endo 07. In an angry open letter to ThyCa’s online support group, Dr. Ain wrote about the post: “Her main interest is to slander endocrinologists and impugn their practices...” He suggested that I was “creating dissent and controversy regarding fictitious conspiracies between academic physicians and pharmaceutical companies.”

Perplexed at what prompted such a vehement response, I did a bit of digging, only to find that in addition to his medical practice and university duties, Dr. Ain works as a paid speaker for Abbott Laboratories. In addition, he is a paid speaker for Genzyme, manufacturer of the drug Thyrogen, used in thyroid cancer treatment. Dr. Ain also performs research under paid contract to Celgene Corporation, manufacturer of a drug being tested for thyroid cancer treatment.

When I pointed out these potential conflicts of interest, Dr. Ain confirmed his financial ties but attempted to defend the relationships, writing: “...it is NOT unethical for academic physicians and professional organizations to utilize funding from biotechnology and pharmaceutical companies for education and research, provided that they fully disclose this funding so that participants can see all...”

Dr. Ain’s comments raise an interesting question. Are doctors who have close financial ties to drug companies able to objectively gauge whether they are being influenced by those ties? Are questionable ties between physicians and pharmaceutical companies fact -- or “fiction?” Does physician disclosure ensure that patients are getting a doctor who is not “under the influence” of pharmaceutical company marketing practices?

I decided to take a look at what the experts have to say.

$21 BILLION DIRECTED AT PHYSICIANS

In January 2006, the Journal of the American Medical Association (JAMA) released a seminal paper that explored the conflicts of interest created by pharmaceutical company influence on medical practice. Authored by academic physicians from Columbia and Harvard universities, the article revealed some startling figures about the extent of drug company marketing.
Approximately 90 percent of the $21 billion marketing budget of the pharmaceutical industry continues to be directed at physicians, despite a dramatic increase in direct-to-consumer advertising. In 2000, for example, the industry sponsored 314,000 events specifically for physicians. Moreover, industry contracted with many hundreds of physicians to serve on advisory boards or speakers bureaus. The purpose behind such industry contacts with physicians is unmistakable: drug companies are attempting to promote the use of their products.
Where is this money going? Typically, it’s being spent on everything from the free pens and prescription pads handed out by drug representatives to doctors’ offices, to paid speaking opportunities for research doctors, to free continuing medical education, to lavish all-expense-paid vacations and entertainment.

But participating in these sorts of marketing practices has increasingly come under fire. Dr. Marcia Angell, a senior lecturer in the Department of Social Medicine at Harvard Medical School, and former editor-in-chief of the New England Journal of Medicine, is an outspoken critic of the coziness between physicians and drug companies. Says Dr. Angell, in an article in the New York Review of Books:

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself....This is an industry that in some ways is like the Wizard of Oz -- still full of bluster but now being exposed as something far different from its image.
The fear that the federal government will enact restrictive legislation is now causing some drug companies to promise greater self-regulation of marketing practices, and some hospitals, universities and medical journals to call for full and better disclosure of these relationships by their physicians. But is that enough? No, say the JAMA authors, who argued for stringent guidelines limiting or even preventing most financial connections between physicians and makers of drugs and medical devices. They argue that physicians’ attempts at self-regulation of conflicts of interest, even if well-intentioned, are simply not effective.
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