WHAT CAN BE DONE?
In the end, the groundbreaking JAMA article made a recommendation –- considered heresy by some doctors -- that in the best interests of patients, industry interactions must be controlled. They suggested eliminating or severely limiting the ability of drug and medical device makers to finance these items:- Gifts, ranging from small, low-value items such as pens, pads or mugs, to sports tickets and lavish vacations
- Meals
- Payment for attendance at lectures and conferences -- including online
- Continuing Medical Education/CME programs for which physicians are not charged
- Payment for time while attending meetings
- Payment for travel to meetings
- Scholarships to attend meetings
- Payment for participation in speakers bureaus
- Ghostwriting of articles for publication under the physician's byline
- Pharmaceutical samples
- Grants for research projects
- Financial incentives to participate in clinical trials
- Payment for consulting relationships
I’d like to believe that, as Dr. Ain claims, that doctors who are paid by drug companies can also be unbiased in their practice. But the research simply does not support this claim.
In the end, I welcome the idea of endocrinologists gathering together, and focusing their best thinking on truly answering the question of “Thyroid Hormone Therapy: Why Some Patients Are Unhappy." But patients deserve to be confident that that discussion -- and its findings -- will not be influenced in any way by the sponsors paying the way.
Without major reform, that confidence is a long way off.
DISCLOSURE STARTS AT HOME: QUESTIONS TO ASK YOUR ENDOCRINOLOGIST
While we can’t expect anything more than self-regulation and disclosure of conflicts of interest from endocrinologists in the near term, you can start by asking some questions. Most doctors will assure you that they are not influenced by their financial ties -- and, as the research shows, they may truly believe they are immune to influence -- but you can still get a sense of the extent to which your doctor is “under the influence” by doing some background research and asking questions.Observe -- Is the doctor’s office filled with posters, prescription pads, pens, and brochures sponsored by drug companies? While you’re waiting, is there a procession of drug representatives coming and going? (They’re usually easy to spot, as they’re most often young, extremely attractive and well-dressed women. Many are even former college cheerleaders. They frequently arrive at doctors’ offices armed with trays of food, tins of cookies, cases filled with drug samples, and other goodies.)
Ask -- Don’t hesitate to ask your doctor directly: “Do you have any financial relationships with the companies that make the drugs you are prescribing for me?” You can also ask your doctor to share his/her resume -- known as a curriculum vitae (“CV”) in the medical world. Often, relationships with drug companies will be spelled out. Some doctors have their CVs posted online, as a web search may reveal.
Read/Research -- If your doctor has been published in any medical journals, check the articles for disclosure statements or references to funding. If your doctor is affiliated with a university, search the university’s website for information on their latest research studies, grants, or trials, to see if you can determine who is funding them.
Advocate -- Find out more about No Free Lunch and its growing directory of doctors who pledge to accept no drug company freebies.
In the end, you may not be able to avoid endocrinologists who are “under the influence,” but being an informed, empowered thyroid patient will go a long way toward ensuring that you get the best possible care from your physician.
Mary Shomon, About.com's Thyroid Guide since 1997, is an internationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough," "The Thyroid Diet," "Living Well With Hypothyroidism," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.
Sources:
Ain, Kenneth, MD. Faculty Disclosure, “Thyroid Cancer: Diagnosis and Clinical Management,” Online.
Ain, Kenneth. Miscellaneous posts to ThyCa support listserv. April 28-30, 2007.
Angell, Marcia, MD, “The Truth About the Drug Companies,” New York Review of Books, Volume 51, Number 12, July 15, 2004, Online.
Blumenthal, David M.D., M.P.P. “Doctors and drug companies.” New England Journal of Medicine, 2004;351:1885-1890, Online
Brennan, MD, MPH; Troyen A., et. al. “Health Industry Practices That Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers,” Journal of the American Medical Association, 2006;295:429-433. Vol. 295 No. 4, January 25, 2006
Online.
Groopman, Jerome, MD, How Doctors Think, Houghton Mifflin Co., NY, 2007.
Katz, Dana, et. al. “All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving.” American Journal of Bioethics, 2003;3:39-46.
RxList.com, Top 300 Drugs by Prescriptions Dispensed Online
Saul, Stephanie, "Gimme an Rx! Cheerleaders Pep Up Drug Sales," New York Times. November 28, 2005, Online
Studdert DM, Mello MM, Brennan TA. “Financial conflict of interest in physician relationships with the pharmaceutical industry: self-regulation in the shadow of federal prosecution.” New England Journal of Medicine,” 2004;351:1891-1900.
Wazana, Ashley, MD “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?”
Journal of the American Medical Association, 2000;283:373-380. Vol. 283 No. 3, January 19, 2000 Online
