The Convoluted Incentives Doctors Face

TW: A recent poll of Americans indicated they trust doctors far more than any other stakeholder in health care (Obama, Congress, insurance companies, etc.). Yet doctors face their own set of convoluted incentives. Doctors are health care vendors. Vendors have interests sometimes aligned with consumers and sometimes not.

Doctors given their tremendous respect within society are ripe for exploitation by other health care vendors. Below is a story of one doctor who ultimately stopped shilling for pharma companies. To be clear doctors are not the only professionals used as shills and shilling does not make one a bad person, but most other professionals do not carry the respect of doctors.

From Milwaukee Journal:
"...James Stein, an up-and-coming heart doctor, was ripe to be hooked as a drug company speaker. Stein, now a professor at the University of Wisconsin School of Medicine and Public Health, was a 29-year-old cardiology fellow in Chicago in 1994 when his faculty mentor asked him to fill in for him at a drug company-funded lecture to a large group of doctors.

It would be his first taste of life as a drug company speaker and consultant.

Stein got first-class airfare to Dallas. A limousine took him to a luxury hotel for the talk.
He walked off the stage, and a doctor from the conference handed him an envelope containing a $500 check.

"I got a pat on the back and he said, 'There's more where that came from, son.' I had no idea what that meant, but I went home and paid off part of my student loans," Stein said in a presentation at UW this month.

Stein was among dozens of UW doctors and an untold number of physicians nationwide who have pulled in large sums doing talks or working as consultants to drug and medical device companies.

Now these financial arrangements are being threatened. Top universities and the medical profession are riding out a gathering storm over the ethics of financial relationships between drug companies and doctors. More and more, restrictions are being placed on these relationships, in part over concerns they raise the cost of drugs, threaten the integrity of medicine and may even be harmful to patients.

Stein's first drug company talk led to more than a decade of work for drug companies before he gave it up for ethical reasons. Now he is speaking out.

Over the years, many of the big names in the drug industry would hire Stein to give speeches or serve as a consultant, eventually leading to fees of $2,000 to $3,000 per talk. Stein told his cautionary story to medical students, doctors and others at a UW conference this month on conflicts of interest in medicine.

..."I was really flattered because over and over again I was told that I was a future thought leader," he said. "I did my talk. I got a $750 honorarium and I was hooked."

Stein said he now realizes that the speech at the hospital was just an audition.

"They wanted to know what I would say and how I would deliver," he said. "And I think they also wanted to know what I would say about their product."

He joined speakers bureaus for several drug companies. It was a kind of badge of honor, he said. The more companies a doctor spoke for, the more highly he or she was regarded.

...For instance, in 2005 Stein did work for six drug makers, according to a disclosure form filed with UW. That year, Pfizer paid him between $10,000 and $20,000 for four days of work as a speaker and advisory board member. LipoScience, a firm that markets a cholesterol test, paid him $10,000 to $20,000 for four days of similar work. Another firm, Schering-Plough, paid him about $12,000 for two days as a lecturer.

Although he said he had concerns about the propriety of his work, Stein said he was assured by his superiors there was nothing wrong with it as long as he did it on his own time. Indeed, they said it enhanced the reputation of the university.

And, he said, he considered himself an educator, not a salesman.

..Things started to change rapidly beginning several years ago. Drug companies began referring to the talks as promotional. They wanted him to use their slides; he refused. Then, medical journals and the lay press began printing articles questioning the ethics of the relationships.

...Stein said he saw no harm in being paid. But he admitted that giving the talks also made him feel important.

..."I have learned that human beings, physicians included, are incapable of recognizing bias in themselves, and even when you try not to be biased it is impossible to avoid it, especially when money is involved," he said.

...He said he came to realize that drug and medical device firms were no longer trustworthy partners in medical education. He also said it has become obvious that patients have the least power and drug companies have the most power.

...But, he added, "I was naïve to think I was not influenced by the money and power of the drug and device companies." As of last December, he said, he stopped all drug company speaking and consulting other than bona fide research."
http://www.jsonline.com/features/health/43933562.html