"Keep doctors independent; ban fees from
drug makers.” Responding to revelations that Eli Lilly paid out $22
million in fees for promotional talks to doctors over the first 3
months of 2009, the Boston Globe believes that “legislators should go beyond
requiring disclosure of the relationships, and ban the practice.”
The Globe Editorial soundly concludes that:
"Patients trust doctors as stewards of their health. They revere them
as scientists who can exercise sound, independent judgment. Allowing
doctors to promote drugs for pharmaceutical companies takes advantage
of that trust and reverence. It also compromises doctors’ most
important work: treating people who are ill."
I agree that doctors should cease speaking for drug companies, though
I’m not convinced that legislation is the best way to accomplish this.
Since the practice is unethical, it should be regulated in the same way
that other matters of medical ethics are regulated—via medical
societies and state medical licensing boards.
At any rate, I perused some of the dozens of comments to the Globe's
editorial, and here are three common categories, along with my
rebuttals.
1. Doctors are not wealthy and greedy. They train hard, only make
around $150,000 per year, have lots of overhead, etc. Doctors are so
poor that they need and deserve to supplement their income by speaking
for drug companies.
Here’s a news flash, people. Most doctors are not poor; in fact, they
are rich. In 2008, the average physician income ranged from a “low” of
$159,000 (family practitioners) to a high of $527,000 (neurosurgeons).
This places their income in the top 5-10% of all American wage earners,
according the health economist Uwe Reinhardt.
Doctors don’t speak for drug companies because they need the money to
feed and clothe their starving families. They do it because it’s fun
and interesting, provides narcissistic satisfaction, a social outlet,
and gives them extra money for the finer things in life. The point of
the editorial is that doctors should make their money by practicing
medicine rather than by promoting drugs.
2. But how will doctors get their medical education if drug companies
can’t pay experts to give lectures?
There are hundreds of medical journals covering every conceivable
specialty—here’s one list of them. Likewise, here is a directory of the
hundreds of medical conferences throughout the US held in every state,
varying widely in cost. Most medical education lectures are held in
hospitals and academic medical centers as part of grand rounds, most of
which are freely available to doctors in the community. The funding
varies, sometimes coming from medical staff fees, sometimes from drug
company money donated to a pool of funds that can be used at the
hospital’s discretion—a far cry from doctors signing contracts to speak
for drug companies.
3. You think doctors are greedy? What about congressmen and
senators—look at all the money they get from drug companies and
insurance companies. That’s where you should focus.
That's just the opinion of one person. Trust yours.
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