March 30, 2011 · 1 comment
Industry Insights from Paul Meade, M.Sc., MPH
Should doctors be paid by drug companies? Well, I guess that depends on the reason for the payment. If a physician, known for her expertise in a given area, is asked by a pharmaceutical company to determine if a newly discovered drug compound would meet a medical need in healthcare, then the answer is clearly yes. Likewise, if a patient consults with an orthopedic specialist on whether to undergo a surgical procedure to repair a damaged cartilage, that consultation is paid for by the person’s health insurance.
In any profession based on an individual’s expertise—think lawyers, management consultants–a person’s informed opinion usually commands some form of payment. Also, the level of expertise generally dictates the level of compensation. So why is it that when a physician gives advice to a patient, or even a group of patients during a patient advocacy lecture, we all feel compensation is fair and just, but when that same person provides his or her expertise to a pharmaceutical company seeking to make a decision on whether to continue the development of a new drug, many people cry foul? Should pharmaceutical companies be forbidden to seek out and pay for the expertise and knowledge of physicians?
In order for a new medicine to become available to the general population, regulatory authorities demand rigorous clinical studies to demonstrate its efficacy and safety. These studies require this new drug to be given to thousands of patients. Since physicians, and some other healthcare professionals, are legally permitted to treat patients, they are the people who can conduct these clinical studies. So if a physician participates in a clinical study, should he be compensated for his time, since documentation for clinical trials is quite time-consuming and laborious? But of course he should be compensated for participating in clinical studies!
Now, if this same physician, who completed a clinical trial for a new medicine, is asked to present the findings of this study so that other physicians can learn about a new treatment option, should this physician be compensated for time away from the practice to give this presentation to colleagues? But of course, unless you can think of a good reason for doing this for free! Would you?
Again, this same physician, who completed a clinical trial and found this new medicine to be highly advantageous to patients and spoke to his colleagues at a medical conference, is now asked to prepare a manuscript for a medical journal so others may understand how to use this new medicine. Should this physician be paid to write this article on behalf of a pharmaceutical company’s study? Once again, there is an obvious answer.
If this clinical investigator is now asked by the pharmaceutical company to go out and speak to other physicians about the results of his research, should this be a compensated activity? It is if it takes time away from a physician’s practice or family. Who wouldn’t want to be compensated for doing this?
Now, the fact that this physician has been paid by the pharmaceutical company for 1) participating in a clinical study, 2) presenting the findings at a medical conference, 3) writing a journal article about the research findings, and 4) presenting the research findings to other physicians might lead one to believe that this compensation will bring an element of bias to what the physician says about the new medicine. But do you suppose that any element of bias might have been derived from the actual results of the study, and not the money paid to conduct this study. Do you not think that if the new medicine would have been completely ineffective with a terrible safety profile, the physician would not be supportive of this drug? If you were fortunate enough to participate in the study of a breakthrough medicine that gave patients a significant treatment option for their disease, wouldn’t you be a bit biased?
Every one of us is prone to some kind of bias at different times. If you purchase a new state-of-the-art plasma television, don’t you tell all your friends what a great TV it is? How sure are you about it being such a great television? Did you do some research on it? Were you influenced by someone else’s opinion?
If a physician has a bias towards a pharmaceutical company’s new medicine, perhaps it was because he participated in a rigorous clinical study and got to see first-hand how safe and effective this drug was for their patients, and not because he was compensated to participate in this research. It’s all about bringing things into balance and seeing it from another perspective, instead of a one-sided bias some people may have about whether doctors should be paid by drug companies.