More Drugs and a Confession from Dr. Brian

The New York Times has a story today about drugmaker Eli Lilly's announcement that from now on, it will publically report on all payments to outside doctors for speaking and consulting services. According to the Times, the company's chief executive announced that beginning in 2009, it intends to post "all its payments to doctors in an online database. The posting will “likely include” the name of the doctor or some other identifying information, along with the reason for the payment, the company said."

This voluntary move follows efforts by the US Congress to establish a national registry of such payments to physicians. A bipartisan bill called the Physician Payments Sunshine Act is expected to be taken up next year. Other pharmaceutical companies say they plan to follow Eli Lily's lead in the next few months.

The idea behind disclosing such information is the fear -- backed by some evidence -- that money from Big Pharma can taint doctors' prescribing habits, their research, and even their clinical judgement.

In the interests of FULL DISCLOSURE, yours truly has given lectures and seminars to MDs that were paid for by pharmaceutical companies. Now, I certainly hope that the talks I've given under those circumstances were fair and unbiased. In the vast majority of cases, the content of my talks has been accredited independently through third party agencies such as the College of Family Physicians of Canada. The purpose of these seminars is educational. Many doctors on both sides of the lectern find these talks extremely useful in helping keep them up to date on the latest developments.

Have I ever been corrupted by money? I'd be awfully precious if I said no, now wouldn't I? One way or another, we're all corrupted by lucre.

In my opinion, the key isn't the corruption. It's the disclosure of competing interests.

The idea of full disclosure is not new. These days, health professionals who submit proposals to do lectures are obligated to disclose any completing interests -- especially whether or not they receive funding from drug companies. The same goes whenever they submit research for publication in medical journals. More recently, provincial Colleges have developed competing interest policies which bind MDs to disclose to patients any relationships with pharmaceutical or other companies that might affect the drugs they prescribe or the treatments they recommend. Disclose these competing interests, and people are free to accept or reject what you have to say.

Full disclosure by pharmaceutical companies themselves is a good step in the right direction.

I applaud efforts by Eli Lilly and other companies to carry disclosure to the next level.

So, time to put my money where my mouth is. From now on, I promise to disclose in this space whenever I give a talk that has anything to do with Big Pharma.


On Sunday October 6, 2008, I'm hosting and speaking at a satellite symposium at the Scientific Assembly of the BC Chapter of the College of Family Physicians of Canada. The title is "Introduction to Chronic Pain Management and the Power of Storytelling". The program has been accredited by the BC Chapter of the College of Family Physicians of Canada. The funding for my talk is through an unrestricted grant from Purdue Pharma, a pharmceutical company. My fee for giving the talk is $2000.00. The fact of the grant was reported to the BC College of Family Physicians prior to accreditation. However, to my knowledge, this is the first time any doctor I know has disclosed publically how much he or she is being paid to give a talk.

See? Didn't hurt a bit! I challenge all of my colleagues to do the same from now on.

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Previous Comments (6)

(...) accredited independently through third party agencies such as the College of Family Physicians of Canada."

As for your conflict of interest disclaimer: "I admit I stole the money; see how honest I am"...we may be loyal CBC supporters, boring, old, stuck in our ways, but we recognize the defense of a toddler caught with his hand in the cookie jar when we hear it.

riv, September 30, 2008 9:15 PM

I love your show, but totally disagree with this post, it is not just about disclosure. It is about INFLUENCE and the appearance of influence.

i too have given talks, been paid outlandish sums for ad boards ( a big huge scam). But no more, we need to clean up our profession.

You as a medical journalist should NOT be doing this, all the available evidence suggests that we are being corrupted. These satellite symposiums (all paid for by specific drug companies) should not be allowed.

Look you are a journalist, you need to be squeaky clean, squeaky.

The other folk that need to be clean are professors, head of departments, chairs of pharmacy and therapeutics committees, heads of hospitals, doctors that sit on committees that decide on what drug a formulary will pay for.

Look Nemeroff (see recent nytime article), great researcher, great, but I watched one recent talk by him, a man in the audience pointed out that he used generic names for all drugs but paxil where he used the trade name ( he has done tons of work on paxil); I noticed the same thing, Nemeroff got very angry at the questioner. I suspect he didn't even notice he was doing it.

People are influenced, they are, stop it, or stop being a journalist. stop lunches and chicken dinners just stop.

K____, October 6, 2008 8:35 PM

Dear K______________. Loved your comments. Would have loved them even more if you put them on the record, as I did in a way that can neither be removed or repudiated.

I think we need to clarify a few things here. I do this show precisely because I bring the perspective of a knowledgeable insider, as opposed to someone from the outside looking in.

These days, full disclosure is the norm in the medical community....in every article written, every lecture proposed or given, and every poster or brochure that adverstises these lectures.

The same rules apply in journalism. It's not that you can't do more than one thing, it's that you must disclose your activities to help guarantee transparency and avoid charges of conflict of interest.

That I have disclosed what I am doing in this space is extraordinary. Moreover, it puts you and I on the same wavelengh, not opposite sides of the fence.

If you want to talk about influence and Pharma, say something new. Instead of taking pot shots at me, why not tell us how you would do things differently? Envision a system entirely free of influence. How would it work?

Let's discuss it.

Dr. Brian Responds, October 7, 2008 9:32 AM

On Sunday October 6, 2008, I'm hosting and speaking... "Introduction to Chronic Pain Management and the Power of Storytelling".

Common law suggests, "You must come before the court with clean hands". I think by making your statement you've achieved that goal. Interesting talk. Can "non attendees" see a copy of your speaking notes now that the conference is over? I’d to read it spread the news. Then the $2000 is really worth it. Cheers, David

David, October 18, 2008 8:06 AM

ll is not what it appears to be on the surface. Examine the outcomes achieved and forget about the cost is my advice and thank God for the medical profession whether they be clinicians or scientists or both.

Dave Spiro, October 20, 2008 10:56 PM

If I don't like what my doctor prescribes to me, because I know he is being influenced by "kick-backs", what can I do? Change doctors? Doctors, taking new patients, turn down people who already have a doctor. Here is why patients think doctors are being influenced by big Pharma: they seem to give a pill for almost compliant.

Lorian, November 9, 2008 1:46 PM
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