There’s been much said already about ProPublica’s latest installment of its “Dollars for Doctors” series, which looks at the industry money in medical specialty societies, using the Heart Rhythm Society and its annual meeting earlier this month as a case study.
Here are some good links to refresh:
Some of the punch of the report comes from the sheer volume of outlay: Medtronic spending $1.6 million on promotion at last year’s HRS annual meeting even as it paid out millions more in settlements on anti-kickback allegations, or the fact that two thirds of the society’s directors are also paid speakers or consultants for the leading defibrillator companies in the industry. (See this post for more on the industry’s recent trouble with the law around illegal marketing.)
Some of it comes from the now much-circulated and unfortunate analogy picked by American College of Cardiology’s CEO Jack Lewin, who compared his professions’ immunity to industry marketing to his choice to drink Coca-Cola – a brand not exactly known for its quiet marketing tactics. In light of the wealth of data on the influence of advertising (it’s an industry for a reason) and small gifts, not to mention the millions of dollars drug and device companies have spent in recent years to settle illegal marketing cases and buy prescriber info to better target sales pitches, Lewin’s was a sort a head-shakingly tone-deaf defense of a question—that drug companies influence physicians—settled long ago.
Otherwise, would a company spend $45-70K (at just one meeting) to get its name on the hotel key of a cardiologist?
As Cardiobrief put it: “Neither Coke nor Medtronic are idiots and they certainly don’t waste their money.”
Dr. Howard Brody over at Hooked blog says to medical professionals: Go take a look at the exhibitor website before you go to the next meeting, and “see how [you yourselves are] being marketed to the drug and device companies as advertising fodder, whose behavior your society more or less promises to deliver over to the industry.”
I want to just underscore a couple of points:
This is not a new problem, or one without proposed solutions. In 2009, nine former leaders of major medical specialty societies got together and established a set of recommendations reduce and eliminate conflicts of interest from medical societies, which “represent expertise and authority to those inside and outside of medicine.” Published in JAMA, it reads as a compact of sorts–one designed to preserve valuable science-based relationships with industry while protecting clinical care and professional medical conduct from the undue influence of marketing. The leaders address industry involvement in operating costs, treatment guidelines, society leadership, medical education, sponsorship, and meetings.
Here’s some of what they say on meetings:
“To distance Professional Medical Associations (PMAs) from industry marketing activities, and in light of the data on the power of gifts to influence treatment choices, conference meetings should not serve as a setting for industry to distribute branded items to members. No company logos should appear on tote bags, lanyards, pens, notebooks, and publications distributed to members at conferences.”
They point out that PhRMA and AdvaMed put these rules in their voluntary codes but made no mention of enforcement.
The authors also say that PMAs should aim to move toward a zero-dollar reliance on industry for general operating costs. (The HRS gets about 50 percent of its annual income from device companies, according to data on its website).
Additionally, the leaders stressed that presidents, officer and board members should be conflict-free during their term of service (ProPublica found that 12 of the Hearth Rhythm Society’s 18 directors are currently paid by or otherwise financially tied to the top three device companies in the defibrillator industry.)
“To allow commercial funding to dictate a PMA’s activities is, in effect, to put the organization up for sale,” the JAMA authors wrote.
Second, HRS is being held up as an example because it made this payment data available on its website, and it should get credit for this policy. While there’s some debate about whether disclosure deters untoward industry/medicine coziness, the value of knowing the extent of these relationships to patients, payers and the public is unquestionable, and offers a reminder about the importance of the coming Sunshine.
–Kate Petersen, PostScript blogger