Monday, July 25, 2011

Big Pharma

I was having lunch with the local Pfizer rep when he told me an interesting story. His company makes a drug for Alzheimer's. A doctor had contacted him to help with a presentation she was giving. His company had developed an assessment tool for dementia and she wanted him to attend to show the attendees how to use it. The problem was that the talk was sponsored by our University's CME department which has recently taken a hard line on pharmaceutical sponsorship. In fact the doctors attending were actually paying out of their pocket (or their corporation's pocket) to attend.

The rep realized that he might not be welcome and so he phoned the CME department to ask if they minded. As expected he got a sanctimonious lecture on the evils of pharmaceutical sponsorship and was of course told he could not attend. Fine, he said, where should I drop off copies of the assessment tool? Our office is in the << insert corporate robber baron >> building, said the CME person.


It is okay to sell naming rights to your university buildings to the highest bidder; it is not okay to accept money or any other help from Big Pharma.

I of course sold my soul years ago. In the last millennium I think. I have always given CME talks. I never really cared how much I got paid for them or how much income I was losing by not doing something else. In the 1990s I was evangelical about chronic pain. I can't remember the first Pharma talk I gave or who I gave it for. All I know is that pretty soon I was doing a lot of talks for various companies. And making pretty good money for it.

I have to say however I was never told what to say or to promote any particular product. I had a generic talk I mostly gave where I reviewed all the treatments for chronic pain. I did use slide kits provided by the companies because they often had good pictures that I could use. If I didn't agree with something on the slide, I either modified it or didn't use the slide. I inserted my own slides, I mixed and matched various slide kits. I also searched Google for really funny pictures. I had a good time preparing the talks and a lot of fun presenting them. I had visions of getting on the national speaker tour but I never got beyond the local dinner circuit.

I should mention that I was never told what I should prescribe either. I did a ton of talks for Purdue even though at that time I mostly prescribed methadone because of the tertiary care nature of my practice. Pregabalin as I tell the Pfizer rep is a nice drug but unfortunately it is isn't covered by most drug plans so there is no point prescribing a drug that they can't afford. Besides gabapentin is just as good (I don' tell them that). Likewise CR tramadol which three companies released at the same time in Canada setting off a marketing frenzy to the benefit of the local restaurants. Duloxetine the same. When it gets covered I will prescribe it. Very few of my patients can afford it. This doesn't stop me from giving talks on it. I have read the research I know they are good drugs at least based on what has been published.

At the same time I started to get involved with the national pain society and got to meet many of the heavy hitters in chronic pain management. And with a few exceptions they were all on the Big Pharma lecture circuit for multiple companies.

Along the way I have gotten to go to some interesting venues courtesy of Big Pharma. These include Vienna, Sydney Australia, and Glasgow for IASP meetings; Cancun, Stockholm, Bermuda, New York, Phoenix, San Diego, Memphis and who knows how many trips to Banff, Toronto, Montreal and Vancouver. Some of these trips I even got paid for in addition to the free trip. I like to think I did some networking, most of the "friends" I have in the chronic pain world I met at these meetings. The trip to Stockholm which was sponsored by Pfizer was an excellent scientific meeting and only mentioned pregabalin once.

Gradually over time Big Pharma developed a code of conduct and the rules changed. They started to get accreditation for their talks for example. What accreditation meant was you had to stick to script. If you didn't like a slide, you could delete it but you could not modify it. You could not add your own slides and no funny pictures. I have done a few of these and they are absolutely unrewarding and I get the sense that the audience is as bored as I am. A real paradox. Without University accreditation I don't have to follow the script and can say what I want. With University accreditation I have to stick to the script which more or less makes me a shill for whatever product I am supposed to talk about.

Between the new rules, the economy and mergers of Pharma companies, I am doing less and less of these. I don't really miss it that much although I wouldn't mind the extra money.

Obviously a bleeding heart liberal like me should be no friend of Big Pharma. If fact most of what they do disgusts me. The problem is that without Big Pharma support most CME would either not exist or be horrendously expensive. I recently went to two meetings that had no pharma sponsorship and they both cost over $2000. I realized early on that the small number of chronic pain consultants in our area and I could not treat everybody and that the primary care docs had to be educated on this. The problem was that nobody really wanted to pay for this so when Big Pharma came calling I jumped on the bandwagon. The opportunity to get to talk to the family docs who sent patients to the pain clinic was the impetus, the money and the nice suppers were secondary. I later was the treasurer of our national pain society and I can tell you that without Big Pharma funding, there would be no meetings and probably no society.

Those of us involved in CME do a delicate dance with Big Pharma. We want to teach other docs about chronic pain. They want to sell drugs. We actually prescribe most of those drugs anyway and we actually want family docs to prescribe those drugs when the indications are appropriate. We actually want them to do a whole lot more and those supper meetings actually give us a pulpit from which to preach our gospel. At least that is what I like to think. But of course I have lost most of my soul.

No comments: