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Rethinking the Use of Physicians as Hired Expert LecturersRethinking the Use of Physicians as Hired Expert Lecturers

Jerry Avorn, MD
[+] Article and Author Information

From Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0847.

Requests for Single Reprints: Jerry Avorn, MD, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120; e-mail, avorn@post.harvard.edu.

Author Contributions: Conception and design: J. Avorn.

Analysis and interpretation of the data: J. Avorn.

Drafting of the article: J. Avorn.

Final approval of the article: J. Avorn.

Collection and assembly of data: J. Avorn.


Ann Intern Med. 2014;161(5):363-364. doi:10.7326/M14-0847
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GlaxoSmithKline recently announced that it will no longer hire physicians to lecture prescribers about its products. This commentary discusses possible motivators behind this decision and why physicians should welcome it.

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Rethinking the Use of Physicians as Hired Expert Lecturers
Posted on September 1, 2014
Emilio Gonzalez, M.D.
The University of Texas Medical Branch (utmb Health)
Conflict of Interest: None Declared
I think the title of this piece should have been "Rethinking the Use of Pharma-sponsored Physicians as Hired Expert Lecturers". Otherwise, the title is entirely misleading. I strongly believe there is a great clinical benefit in listening to physicians who are indeed medical experts in their fields both in medical education for trainees as well as in improving the quality of care provided by practicing physicians.
A lost opportunity
Posted on September 3, 2014
Abrar Khan
Banner Health
Conflict of Interest: None Declared
As far I can remember, great ideas didn't come pre-printed in journals or text books. They come from free minds speaking freely about a subject or an issue while sipping a cup of coffee, sharing a meal or a drink. It sounds very demeaning that respected well paid physicians will change their practicing behavior, and put aside their patient care for just a meal. It’s not relevant who pays for a dinner and who sponsors it. What’s more important is that it’s an effort to get few physicians start taking about patient care in the context of a new therapy that might help their patients. Thanks to the bureaucracy of few, now a lost opportunity……
Professionalism
Posted on September 3, 2014
Marc S. Frager MD
East Coast Medical Associates
Conflict of Interest: None Declared
Dr. Avorn tells us that "professionalism means taking responsibility for one's lifetime learning," yet the ABIM believes a physician has to meet their criteria for lifetime learning to demonstrate professionalism. Perhaps the ABIM is minimizing the potential for physician self-education and self-motivated displays of professionalism by urging their expensive and contentious MOC program on us.
Comment on Rethinking the Use of Physicians as Hired Expert Lecturers
Posted on September 9, 2014
Marc B. Garnick MD1, Wendy Balter2
1. Gorman Brothers Clinical Professor of Medicine Harvard Medical School and Beth Israel Deaconess Medical Center Boston, MA 2. President, Phase Five Communications, Inc., New York, NY
Conflict of Interest: Marc B. Garnick has no conflicts of interest; Wendy Balter is President of Phase Five Communications, a medical education company.
Responding to Dr. Avorn’s opinion piece (1), we find lamentable GlaxoSmithKline’s (GSK) retreat from support of physician lecture programs at a time when the introduction of novel pharmaceuticals with complex mechanisms of action and clinicians’ desire for education have never been greater.

In 2013, the US Food and Drug Administration (FDA) approved 27 new drugs, many of them completely novel. Commercially-supported physician lectures answer an urgent need for high-quality information about new drugs from experienced peers. The content of these programs is rigorous and satisfies the FDA’s stringent requirements for accuracy, objectivity, fair balance, and reliance on well-controlled studies. Commercial interests are fully disclosed, and layers of oversight—from corporate integrity agreements, compliance with the U.S. Department of Health & Human Services Office of Inspector General guidelines (2), and adherence to the PhRMA Code on Interactions with Healthcare Professionals (3)—protect prescribers and patients from unsupported claims that could lead to inappropriate use.

In contrast, non-commercially-sponsored lecturers, including academicians and other key opinion leaders, typically have accountability only to themselves and their institutions. These speakers may lack legal compulsion to disclose conflicts of interest, and may be motivated by drug costs, politics, desire for peer admiration, or fear of change. Little prevents them from advocating uses unproven to meet FDA standards of safety and efficacy.

Absence of commercial sponsorship does not ensure freedom from bias, nor does commercial support necessarily compromise objectivity. Medical, legal, engineering, and accountancy journals, for example, have long enjoyed subsidy provided by their advertising pages while trusting their readership to discern information from promotion.

In a recent independent survey of 500 clinicians, more than 90% responded that they found information provided by sponsored speakers to be timely, useful, and reliable; 94% agreed that these programs improved their care for patients (4). Clinicians also demonstrate that they value commercially-sponsored speaker programs for the information provided, not “complimentary meals.” According to Manhattan Research, 71% of physicians participated in online medical conferences last year (5).

High-quality medical education programs require substantial expertise, time, and other resources to produce. Further declines in commercial support for them would seriously compromise physician knowledge and. ultimately, patient care. The authors hope that other pharmaceutical manufacturers do not follow GSK’s lead, and that GSK rethinks this unfortunate decision.

References
1. Avorn J. Rethinking the use of physicians as hired expert lecturers. Ann Intern Med. 2014;161:363–364.
2. U.S. Department of Health & Human Services. Office of Inspector General. OIG Compliance Program Guidance for Pharmaceutical Manufacturers. May 2003. https://oig.hhs.gov/authorities/docs/03/050503FRCPGPharmac.pdf. Accessed September 3, 2014.
3. Pharmaceutical Research and Manufacturers of America. Code on Interactions with Healthcare Professionals. July 2008. http://www.phrma.org/sites/default/files/pdf/phrma_marketing_code_2008.pdf. Accessed September 4, 2014.
4. KRC Research. Survey of Physicians About Pharmaceutical and Biotech Research Company Activities and Information. March 2011. http://www.phrma.org/sites/default/files/pdf/krcsurveyofphysicians_1.pdf. Accessed September 4, 2014.
5. Manhattan Research. Taking the Pulse® U.S. 2013. New York, NY: Manhattan Research, 2013. Available at ehealthcaresolutions.com/summit/presentations/mressi_2013.pptx.
Accessed September 5, 2014.
Prescribers as Promotors
Posted on September 15, 2014
Kaenat Mulla, Adebusola Shonubi, Dev Katarey
St. Georges University
Conflict of Interest: None Declared
We read with interest the recent article by Dr. Jerry Avorn (1). GlaxoSmithKline (GSK) is an internationally renowned pharmaceutical agency and we believe their recent decision to discontinue hiring physicians as expert lecturers is not without significant consequences.
Within the article it is presumed that physicians’ desire to lecture is due to the monetary reward. However, a study conducted amongst senior Norwegian medical students stated that only 17.5% had a positive attitude towards pharmaceutical industries and the majority said they would decline monetary gifts (2). This study demonstrates that the new generation of physicians are not as influenced by a drug company’s monetary offers. Therefore, GSK’s plan to stop hiring physicians as expert lecturers could mean the future physicians who truly had a desire to educate could potentially miss out on opportunities to teach and share their knowledge. This can be combated by GSK assessing physicians teaching content beforehand.
In the article it is mentioned that an excellent alternative to educate doctors about evidence-based prescribing, free of commercial influences, was by “academic detailing”. (3) The fact that countries such as the USA have started to implement such methods means that it opens up new pathways for physicians to learn and at the same time not be influenced by drug companies, but rather the evidence behind drugs. However, evidence–based prescribing should not take away the knowledge or skills taught by expert lecturers.
One argument in the article was the “physicians’ performance of paid speaking engagement seems to be diminishing”. (1) If we were to compare this to teaching in medical and pharmacy schools, then the majority of lecturers are actually physicians. A study conducted amongst pharmacy students in Saudi Arabia concluded that 53.7% students preferred direct type of lecturing and their aid for revision were handouts made by the lecturers (4). Secondly, postgraduates who have had training and feedback from physicians in terms of their practical skills do better in OSCE’s (5). This shows that the performance is not diminishing but that practicing physicians are used to be being taught by colleagues and subsequently have trust in information provided by them.
As physicians will be the front-line prescribers it is logical that they would educate their peers. It is a shame that GSK are no longer using such a good resource as we believe that physicians provide pharmaceutical knowledge in a more clinically oriented way.
References:
1. J. Avorn. (2014). Rethinking the use of physician as hired expert lecturers. Ann Intern Med. 2014 Sep 2;161(5):363-4. doi: 10.7326/M14-0847.
2. Lea D, Spigset O, Slordal L. Eur J Clin Pharmacol. 2010 Jul;66(7):727-33. doi: 10.1007/s00228-010-0805-6.
3. Thomson O’Brien MA et al. Educational outreach visitis: effects on professional practice and healthcare outcomes. Cochrance database syst. Review. 2000: CD000409
4. Yousif MA et al. Saudi Pharm J. 2014 Sep;22(4):309-14. doi: 10.1016/j.jsps.2013.06.005.
5. Stojan JN. Med Teach. 2014 Aug 26:1-8. Medical school handoff education improves postgraduate trainee performance and confidence.

Authors:
Kaenat Mulla, Adebusola Shonubi and Dev Kata
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