|
Cash incentive for speaker: A new trend?
Many pediatricians are now openly
paid (in cash per lecture) by pharma
companies to deliver scientific lectures
endorsing company’s products. Most are
obliging and some of them are even
demanding higher incentives. What are
your views on this trend? Do you endorse
this practice?
- Vipin M. Vashishtha,
Bijnor-246701(UP,)India
The
Issue:
“Should
IAP experts/members accept money from
pharmaceutical companies for delivering
scientific lectures endorsing their
products?”
FOR:
|
Yash Paul, Jaipur |
"Reasonable amount can be
considered innocuous”
Dear Dr Vashishtha,
I would like to split the theme
in two sections: one, scientific
lecturers (and presentations),
and, two, endorsing 'the
products'.
The doctors who contribute
chapters for the books get a
complimentary copy of the
publication. Those who work in
medical colleges or big
hospitals may be getting the
facilities from the institute
for preparing the material. I
have to spend money for getting
the manuscript typed and
retyped. Similarly for
'power-point' presentation I
have to pay handsome money. Even
this piece of writing will
nibble my pocket.
|
|
I have to take leave from the
hospital for making a
presentation outside Jaipur and
lose money during my absence
from Jaipur, which I would have
earned from my patients. These
activities may be considered a
service to science or
fraternity, but the doctors have
to spend money to render a
service, whereas others get paid
for rendering any service; so, I
believe it would be a good idea
if the speaker is paid some
reasonable compensation, not a
big amount. Reasonable amount
can be considered innocuous, but
large amount may be considered
enticement. Although, it may be
difficult to quantify
'reasonable amount' but, say Rs.
1000/- for a lecture may be
considered. But, amount should
be paid as white money i.e. by a
cheque only. |
The issue of 'endorsing a product' is
tricky. I would like to elaborate by
hypothetic situations. As a participant
in a discussion regarding management of
fever, we should state only generic
names of antipyretics like paracetamol
(not calpol or metacin etc.) mefanemic
acid or ibuprofen, even if the event has
been sponsored by manufacturer of some
antipyretic. Similarly, during
presentations of issues regarding
vaccines we should state the vaccines
like DTaP or MMR. During discussion or
question and answers following the
presentation, the superiority of a
particular brand may be highlighted, but
not mentioned in the presentation.
-Yash Paul, A-D-7, Devi Marg, Bani Park,
Jaipur - 302016, India.
AGAINST:
|
Puneet Kumar, Delhi |
“IAP stands for Indian Academy
of Pediatrics and not Indian
Amalgam of (materialistic)
Pediatricians.”
Globally, pharmaceutical
sponsorship and the ensuing
challenges is a hot topic of
discussion today. But the
question usually is, whether
free gifts be received from
medical representatives; whether
travel subsidies for attending
conferences are ethical; how to
minimize conflict of interest;
how to remain unbiased under
pharmaceutical companies’
pressure to prescribe/endorse
particular drug? However, I am
deeply anguished to see that a
question like above has come up
for a debate. It depicts the
extent of our moral degradation.
My head hangs in shame and blood
is boiling in anger. How can a
talk delivered by an “IAP
expert” endorsing a particular
brand be called a “scientific
lecture”? It is nothing but
drug-promotion/marketing by the
company through the IAP. Why
should then any IAP expert
endorse any particular brand in
the first place? The question of
accepting money does not arise
at all!! Most delegates attend
conferences to update their
knowledge on latest developments
in Pediatrics and expect
unbiased (“scientific”) views on
various products. Anyone having
even an iota of doubt on this
should see the sea of difference
between lecture-halls hosting
panel-discussions/meet the
expert sessions and those
hosting the “sponsored symposia”
in any Pedicon…Jam-packed halls,
pin drop silence and eager faces
in the former and jovial
(“holiday”) mood, thin
attendance in the latter. Do we
wish to combine the two?
|
Doctors and the pharmaceutical industry
share a number of common interests. For
example, both are concerned with
encouraging effective and responsible
use of existing drugs in treatment and
care, monitoring of their use, and
innovative research. However, it should
be clearly understood that the parties
have different emphases and focus on
different stakeholders. The primary
stakeholder in patient care is the
patient, whereas the principal
stakeholder in industry is the
shareholder. The association between
doctors and drug companies serves
commercial objectives of industry and
acquisitive interests of clinicians
rather than legitimate care, educational
or research goals, thereby compromising
the primary ethical obligation of
doctors to patients, dividing the
loyalties of doctors and undermining the
basic trust on which clinical
relationships depend. How can one
believe that the custodians of faith and
the advocates of children have only the
interest of the children of this country
in their minds?
Conflicts of interest are ethically
perilous because they may harm patients,
impair physicians’ judgments, and
undermine trust in physicians. It is a
misconception among many health care
professionals that they can ignore
influence from commercial interests.
Human judgment research indicates that
decision-makers are generally unaware of
biases affecting their decisions (1) and
monetary considerations transcend common
sense. Studies have found that mere
interactions with pharmaceutical
representatives lead to non-rational
prescribing (2-4); decreased prescribing
of generic drugs (5); increased
awareness, preference and rapid
prescribing of new drugs (6); and
increased prescribing cost (7). A survey
of 120 physicians in Cleveland, Ohio,
showed that those who met with
pharmaceutical representatives were 13.2
times more likely to request inclusion
of the company's products in their
hospital formulary; those who accepted
money to speak at symposia were 21.4
times more likely to do so (.
Sponsorship of conferences has been
shown to lead to bias in favour of the
sponsoring companies' drugs (9, 10),
with increases in prescriptions for
sponsors' drugs in the six months after
an event (11). Similarly, pharmaceutical
support for continuing medical education
(CME) activities leads to increased
prescribing of sponsoring companies'
products (9-15). This occurs even when
the course content is controlled by the
society or institution and the drugs are
referred to by their generic names only
(9). If that is so, then the damaging
effect of pharmaceutical marketing from
the forum of a professional body in a
talk given by an “expert” of that body
is not hard to imagine. The kinds of
impressions that people go away with
will be significantly altered. It is
blatantly criminal.
Once a snow balling effect starts it is
difficult to stall the slide. When the
organizational ethics have gone so low,
what message goes to individual members?
If IAP experts think of charging fee for
endorsing a product, isn’t a practicing
pediatrician justified in prescribing a
product to get a few more pens and the
like? I am sorry, but IAP stands for
Indian Academy of Pediatrics and not
Indian Amalgam of (materialistic)
Pediatricians.
Yes, today’s world is materialistic and
we need money….and more money.…for
everything - from running an
organization to organizing grand
conferences to conducting research, and
what not. Where will money come from?
Even today, Gandhian Philosophy holds
water. The philosophy does not mean to
live life in bare essentials, but does
emphasise cutting down on lavish
expenditures. Serious concerns have
often been raised on the extravaganza in
National Conferences (16, 17). Just as a
small example, it has been estimated
that over Rs. 36 lacs are spent on
sending the invitation brochures alone
(16)...and it was 6 years back! Can’t we
cut down on this when official journal
reaches every member of IAP? Another
facet of Gandhian Philosophy is to
generate own resources and be
self-reliant. Why can’t we explore
alternative sources of income? The IAP
Textbook of Pediatrics has been a great
hit. IAP is coming with a number of
publications on various sub-specialities
and guidelines on various pediatric
illnesses. A post-graduate textbook can
be thought of. We, the doctors, are
undoubtedly the best brains of the
humanity. Can’t we think of even better
sources of income? Or are we “happy”
with this trap of corporate colonization
of Medicine? At least, this money should
not come from the pocket of the
unsuspecting patient and put in to the
pharma’s coffers. And also partake a
part of it.
I have no doubt in my mind that if such
ghastly suggestions keep coming up, and
worked upon, the medical conferences
will soon become entertainment events
like WWF wrestling events, which are
more a tamasha than a sport.
I couldn’t find stronger words to
condemn this suggestion of bribery.
- Puneet Kumar, Kumar Child Clinic, New
Delhi
References:
1. Weber LJ, Wayland MT, Holton B.
Health care professionals and industry:
reducing conflicts of interest and
established best practices. Arch Phys
Med Rehabil, 2001: 82(12 Suppl 2):
S20-4.
2. Haayer F. Rational prescribing and
sources of information. Soc Sci Med
1982;16:2017–23.
3. Wazana A. Physicians and the
pharmaceutical industry. Is a gift ever
just a gift? JAMA 2000; 283: 373-380.
4. Lexchin J. Interactions between
physicians and pharmaceutical industry.
CMAJ 1993; 149: 1401-1407.
5. Bower A D, Burkett G L. Family
physicians and generic drugs. J Family
Pract 1987;24:612–16.
6. Peay M Y, Peay E R. The role of
commercial sources in the adoption of a
new drug. Soc Sci Med 1988; 26:1183–9.
7. Caudill T S, Johnson M S, Rich E
C, et al. Physicians, pharmaceutical
sales representatives and the cost of
prescribing. Arch Fam Med 1996; 5:201–6.
8. Chren MM, Landefeld S. Physicians'
behaviour and their interactions with
drug companies. JAMA 1994; 271: 684-689.
9. Bowman MA. The impact of drug
company funding on the content of
continuing medical education. Mobius
1986; 6: 66-69.
10. Ray M. Who pays for the pizza?
Redefining the relationship between
doctors and drug companies. 1:
Entanglement, BMJ 2003; 326:1189–92
11. Bowman MA, Pearle DL. Changes in
drug prescribing patterns related to
commercial company funding of continuing
medical education. J Contin Educ Health
Prof 1988; 8: 13-20.
12. Hodges B. Interactions with the
pharmaceutical industry: experiences and
attitudes of psychiatry residents,
interns and clerks. CMAJ 1995; 153:
553-559.
13. Orlowski JP, Wateska L. The
effects of pharmaceutical firm
enticement on physician prescribing
patterns. Chest 1992; 102: 270-273.
14. Lichstein PR, Turner RC, O'Brien
K. Impact of pharmaceutical company
representatives on internal medicine
residency programs. A survey of
residency program directors. Arch Intern
Med 1992; 152: 1009-1013.
15. Komesaroff PA, Kerridge I H.
Ethical issues concerning the
relationships between medical
practitioners and the pharmaceutical
industry. MJA 2002; 176:118–21.
16. Agrawal S. Pharmaceutical
Industry and Sponsorship of Delegates
for National Conferences. Indian
Pediatrics 2002; 39:445-448.
17. Srivastava RN. XXXIX Annual
Conference of IAP. Indian Pediatr 2002;
39: 444-445.
(The entire debate
is available at Pediascene forum under
the head, “The New trend?” Kindly log on
to:
http://www.itindustries.com/messageboard/viewtopic.php?t=52
) |
Home