WASHINGTON — Representatives of Maine’s medical industry welcomed news this week that one of the largest pharmaceutical companies will stop paying doctors to promote its brand drugs to other physicians.
“I think it is another indication that times are changing and that these relationships will be kept at arm’s length, as they should be,” said Gordon Smith, executive director of the Maine Medical Association.
On Monday, the pharmaceutical giant GlaxoSmithKline announced plans to stop paying doctors to deliver speeches to other physicians on behalf of the company’s prescription drugs. The company, which makes such big-name drugs as Advair, Flonase and Zantac, plans to halt the practice by 2016.
“We recognize that we have an important role to play in providing doctors with information about our medicines, but this must be done clearly, transparently and without any perception of conflict of interest,” Sir Andrew Witty, CEO of GlaxoSmithKline, said in a prepared statement.
The company is the first major drug manufacturer to take such a step, although the industry as a whole has scaled back its use of doctors to promote specific drugs as scrutiny of drug industry-doctor relationships has increased. Broad, mandatory disclosure rules are set to take effect next year as part of the Affordable Care Act.
“I think the announcement is part of a longer-term change in drug industry marketing,” said Dr. Daniel Carlat, director of The Pew Charitable Trusts’ prescription project, which examines transparency and conflict-of-interest issues in the industry.
“What we have been seeing is, companies are re-evaluating how they are spending their marketing dollars and they have become very sensitive to (concerns) about paying doctors to give lectures to other doctors,” Carlat said. “So the drug companies have been getting a lot of push-back.”
‘PROMOTIONAL SPEAKING’ IN DECLINE
Paying doctors to talk about particular drugs is a tradition in the medical field. Critics say the paid lectures raise conflict-of-interest concerns. Defenders say the lectures help busy physicians learn about the latest treatment options from their peers.
In 2012, 26 Maine doctors received a total of $181,960 from pharmaceutical companies to deliver speeches, according to the “Dollars for Docs” database compiled by ProPublica, a public interest journalism organization. That total was down from $362,174 in 2011 and from $472,110 in 2010.
Nationwide, spending on “promotional speaking” decreased from $13.2 million per fiscal quarter in 2010 to $2.5 million per quarter in 2012, according to ProPublica’s analysis of disclosures filed by 15 drug companies.
Several Maine physicians totaled more than $100,000 in speaker’s fees in the years from 2009 to 2012. And pharmaceutical companies’ payments to Maine doctors for research or consulting rose considerably during that time, according to the database.
Many academic institutions, medical associations and hospitals require disclosure or have enacted stricter rules governing interaction between doctors and pharmaceutical companies. Carlat, with The Pew Charitable Trusts, said 44 medical schools now restrict their faculty members from being part of any pharmaceutical company’s “speaker’s bureau,” up from just four schools in 2008.
Beginning next year, a provision of the Affordable Care Act will require disclosure of payments or other gifts from drug makers or manufacturers of medical supplies.
HOSPITALS WARY OF DRUG MARKETING
Eastern Maine Medical Center in Bangor no longer accepts sample medications at its practices because of the possibility that doctors could end up prescribing a name-brand medication more often than an equally effective and less costly generic.
The hospital also requires full disclosure of any links to any pharmaceutical company whenever a doctor seeks to join, requests that a particular medication be added to the formulary, or gives a paid speech.
“We have tried hard to be transparent and to eliminate some of the effects of what we see as marketing by the pharmaceutical companies,” said Dr. James Raczek, senior vice president of operations and chief medical officer at Eastern Maine Medical Center.
Raczek acknowledged that there is a vibrant debate in the medical community about the relationship between physicians and drug companies.
Some doctors insist that they would never compromise their clinical work because of payments from a company. But Raczek said he is concerned about conflicts of interest and was pleased to hear GlaxoSmithKline announce that it would change its practices.
“I think it’s a good step and I hope others do follow suit,” he said.
HARDER FOR DOCTORS TO STAY INFORMED
Other Maine doctors aren’t as sure about where the industry is headed.
Dr. Robert Weiss, a nationally respected cardiologist in Auburn, received more than $40,000 in speaker’s fees from 2009 to 2012, on top of more than $400,000 he received from pharmaceutical companies for research in the same period.
Weiss said not all paid lectures are tilted in the sponsoring company’s favor. If done properly, such lectures provide valuable lessons about potential treatments, including treatments other than those offered by sponsors, he said.
“There were a lot of examples of it being done well, but certainly examples where it was not,” he said.
Weiss said pharmaceutical companies now often require speakers to stick to scripts or use company slides – a clear indication that a lecture is more advertising than education. As a result, he said, he largely steers clear of giving lectures “because I don’t like the constraints of just doing the party line.”
Yet the industry’s changes could make it more difficult for doctors to stay up to date, he said. Many physicians no longer make hospital rounds, attend conferences or even meet with pharmaceutical representatives, so they have to learn about developments in the field from medical journals.
“So if a new drug comes out, how will doctors learn about it?” Weiss said. “It’s not clear how that will happen.”
Smith, with the Maine Medical Association, said the days are gone when drug company representatives would pay for doctors’ trips to conferences, rounds of golf or pricey meals. Yet he said there is still controversy over links between physicians and pharmaceutical companies.
And with the increased transparency measures, he often tells doctors in Maine that they should think carefully about agreeing to anything that could create perception problems among their patients.
“It’s really a different world out there,” Smith said.
Kevin Miller can be contacted at 317-6256 or at: