Ethical Interactions with Industry: Avoiding the Siren Song

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Dr. McMains' Real and Perceived Conflicts of Interest. Stryker- Consultant, Instrument DevelopmentOlympus- Consultant Endoscopy Development, SpeakerMedtronic- Consultant, Biofilm studiesDaichi-Sankyo- Speaker's Bureau. Why are we talking about this?. Retail spending on prescriptions has more than doubled between 1995 and 2000 from 64.7 billion to 132 billion (www.nihcm.org/innovations.pdf)Marketing accounts for over 30% of revenues in the pharmaceutical industryApproximately 90% of the 21 b23

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Ethical Interactions with Industry: Avoiding the Siren Song

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1. Ethical Interactions with Industry: Avoiding the Siren Song… K. Christopher McMains, MD Assistant Professor Associate Program Director Department of Otolaryngology UTHSC-San Antonio March 11, 2008

2. Dr. McMains’ Real and Perceived Conflicts of Interest Stryker- Consultant, Instrument Development Olympus- Consultant Endoscopy Development, Speaker Medtronic- Consultant, Biofilm studies Daichi-Sankyo- Speaker’s Bureau

5. Scenario While rotating on the Otolaryngology service as a medical student, you encounter a pharmaceutical representative who offers you a copy of a recent article on the drug that he details. What issues are involved in this interaction?

8. What is ‘Conflict of Interest’ in the clinical setting? When interests of the clinician do not align with the interests of their patients.

9. Therapeutic Role of Trust Trust has been called “a basic building block for healing doctor/patient interactions.” (Rogers DE, 1994) Outcomes may be related to patient ratings of their doctors. (Franks P, et al, 2005)

10. What do patients think? Patients surveyed thought “it is not alright” for physicians to accept: Dinner at a restaurant 48.4% Baby formula 44.2% Coffee Maker 40.7% Ballpoint pens 17.5% Medical books 16.9% Drug Samples 6.9%

11. What do patients think? Patients thought gifts more influential and less appropriate than physicians. Half of patients were unaware of gifts to doctors from industry. Of those who were previously unaware, 24% had an altered perception of the medical profession.

12. Wonder Drug Inspires Deep, Unwavering Love Of Pharmaceutical Companies March 6, 2006

13. Scenario #1.1 The same representative has left medication samples, lunch and pens in the ENT clinic. What are the issues here?

15. Samples are for the good of needy patients, right? Int. Med residents’ prescribing patterns of 5 drug class pairs were studied Decreased use of unadvertised drugs Decreased use of OTC drugs Trend towards a decrease in use of less expensive drugs

16. Are Medical Students insulated? Survey of Finnish medical students 44% attended industry sponsored presentations >2 times per month Importance attached to industry-supplied information and intensity of interaction increased through training

17. Or is it? Survey of 105 residents at an Internal Medicine residency program: Judged appropriateness based on cost All who viewed lunches/pens as inappropriate had accepted them 61% believed that industry contact did NOT affect their own prescribing 16% believed that others in their program were unaffected

19. Attitudes of Practicing Physicians “Strongly disagree” that their prescribing behavior could be influenced “Slightly disagree” that taking gifts was inappropriate “Slightly averse” to having relationships made public SELF-SERVING BIAS

23. World's Scientists Admit They Just Don't Like Mice

24. Scenario #1.2 You are offered a stipend to attend a meeting being held in scenic and lovely Del Rio at which data on his company’s new drug will be discussed. No CME is offered for this event. What are the issues here?

25. Industry and CME Study of GPs in Scotland ½ of meetings/conferences were funded by industry 1/3 of meetings would not have been attended without industry funding 40% thought industry funding created COI 86% denied that industry involvement affected their drug selection.

26. Industry and Research Funding Industry-funded studies are more likely to report positive outcome. Involvement of drug company employee has a much greater effect on outcome than financial sponsorship

27. Industry and Research Funding Study of NEJM and JAMA articles (2001) 16.6%-32.6% of articles had one or more authors with COI 38.7% of drug studies had authors with COI Strong association between authors with COI and positive reported finding.

28. Summary Relationships with industry can create conscious and unconscious conflicts of interest. If is morally and therapeutically vital that we uphold our patients’ trust in our interactions with industry.

29. Final Thoughts “You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love, and tenderness to your fellow-men. Once you get down to the purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with abreadth of charity that raises you far above the petty jealousies of life.

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