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.

For decades, the pharmaceutical industry has had a good working relationship with the medical profession. Of course, pharmaceutical companies have always been dependent on physicians writing prescriptions for their products, and for pharmacists filling these prescriptions, so ultimately the patients could return to health. This has been a true symbiotic relationship where pharmaceutical companies needed doctors to prescribe their drugs, and physicians had effective medicines to offer their patients.

Occasionally, there were a few bad apples on both sides of the equation that overstepped the boundaries of this relationship, but for the most part, it worked well. So what happened? Why the Sunshine Act? And why the apparent “witch-hunt” to expose every Thought Leader that engages with someone from a pharmaceutical company? Is it time for a course correction? Don’t we have bigger problems to deal with in the financial and economic arenas than to worry about how much money a Thought Leader made from conducting clinical studies or speaking at a conference on behalf of a pharmaceutical company?

Where did it all go wrong? How do we fix it? And what does the future hold for this pharma-medical relationship? Healthcare costs have been steadily rising in most countries across the globe. And while there have been increases in these costs, almost no other country has a high a cost for healthcare delivery than the United States. Healthcare reform has been on the political agenda of Presidents for over 20 years, prompted by the desire to do something about these rising costs. And despite the fact that drugs represent about 10-12% of the total healthcare bill, the public seems to hold negative sentiments about the industry. So when a respected Thought Leader in healthcare has been shown to have received several thousands of dollars from a drug company for a variety of consulting services, the public reacts with contempt and disdain for both parties. There are two burning questions concerning the issue of this pharma-medical relationship: what is a reasonable amount of compensation for services rendered by a Thought Leader, and what is a reasonable amount of absolute money a Thought Leader should receive from one or several pharmaceutical companies?

There have been numerous independent studies exploring the issue of fair and reasonable compensation for the types of consultative services provided by Thought Leaders, so I will forego discussing that topic. Suffice it to say that I believe fair and reasonable compensation has now been established and adopted by most in the industry. So how much should a Thought Leader make from drug companies? And that is like trying to answer the question, how long is a piece of string? Well, it depends! What are the activities being performed by the Thought Leader? How often is a Thought Leader consulted on medical issues? What is the value of the advice given to a company by a Thought Leader?

While it is true that some top global Thought Leaders can earn several hundred thousand dollars in consulting fees and clinical research compensation, it is also true that some make next to nothing from drug companies. Should academic medical centers or medical associations set the limits on what a Thought Leader can earn from consulting with the pharmaceutical industry? Many are attempting to do just that, place a capitation on what a physician can make from a company. Even some politicians are trying to limit compensation from drug companies. Is this an optimal solution to the issue? Not likely!  Part of the problem was that some Thought Leaders were not disclosing what they received from drug companies, and when investigative reporters discovered some of the higher amounts received by physicians, they felt it was their journalistic duty to plaster it all over the front pages of local and national newspapers. Is this an optimal solution to the issue? Not likely!

So where do we go to fix this tarnished working relationship? The answer lies in the simple word, transparency. Companies become transparent in what amount of compensation they provide Thought Leaders, and Thought Leaders become transparent in what they receive from drug companies. Then there are no surprises when investigative reporters go snooping for a story. Will the pharmaceutical industry and the medical profession come to some agreement as to fair and reasonable limits to compensatory remuneration for appropriate services rendered? Yes, they will, if for no other reason than to appease the “witch-hunters.” Will the working relationship be restored to somewhat normal levels? Yes, it will, because neither party is going to disappear any time soon, and this symbiosis has worked well in the past. Of course, there will be changes to the rules of engagement, but in the end it will be for the better. So with the spirit of cooperation and transparency acting as guiding ethical principles, the future of Thought Leaders in healthcare will continue to play a vital role in the system of healthcare delivery.