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Should doctors be paid by pharmaceutical companies to promote their drugs?

December 17, 2013 at 12:00 AM EDT
GlaxoSmithKline has announced it will no longer pay doctors to promote its drugs, nor reward sales representatives based on how many prescriptions doctors write. Judy Woodruff gets views on the business and ethical issues at play from Dr. Jerry Avorn and Dr. Thomas Stossel, both of Harvard Medical School.
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TRANSCRIPT

JUDY WOODRUFF: Now drugs, doctors and the relationship with the pharmaceutical industry.

Those connections have long been the subject of ethical and business concerns, particularly when it comes to the financial ties between doctors and the drug companies. Yesterday, one of the world’s biggest pharmaceutical companies, GlaxoSmithKline, announced changes to some of its practices. It will no longer pay doctors to promote its drugs, and it will stop compensating sales representatives based on the number of prescriptions doctors write.

The moves come following other problems for the company, including a bribery scandal in China involving payments to allegedly boost sales, and a settlement with the U.S. government last year on marketing drugs for improper uses.

We look at these changes. And both our guests are professors at Harvard Medical School and affiliated with Brigham and Women’s Hospital, but they have different views, Dr. Jerry Avorn and Dr. Thomas Stossel.

Welcome to you both.

Dr. Avorn, let me start with you. What is it — explain to us a little bit more about what is it that many doctors are doing and how many are doing it? How widespread is this?

DR. JERRY AVORN, Harvard Medical School: Well, Judy, it’s quite common for drug companies to hire doctors to be on what they call speakers bureaus, in which the doctor will travel around and give lectures about a drug.

And, in many cases, the slides and the content and script are actually prepared by the drug company, and the doctor presents this information as the latest information about diabetes or blood pressure or whatever. And it’s not always clear to the audience that this is material that was really scripted completely by the drug company that was paying the doctor to give the talk.

JUDY WOODRUFF: And how long has this kind of thing been going on, Dr. Avorn?

JERRY AVORN: Oh, this has been going on for decades, and it’s probably not the best way for doctors to learn about drugs in a fair and balanced matter.

JUDY WOODRUFF: Dr. Stossel, what would you add to that in terms of what doctors are doing now, or many are them are doing, for the drug companies?

DR. THOMAS STOSSEL, Harvard Medical School: Well, I agree with Dr. Avorn that it’s — it was very common practice for a majority of doctors, have some relationship, whether in the marketing side or research, with drug companies.

And that has been in parallel with improved longevity and life quality, so the idea that it somehow is problematic is just not clear. But it is extremely common.

JUDY WOODRUFF: Extremely common, meaning most doctors do something like this, or is it just really impossible to say?

THOMAS STOSSEL: Well, there have surveys that have shown that up to three-quarters of doctors and that ilk have some kind of financial relationship with the company, not necessarily speaking. That’s just one of many, many forms of collaboration.

JUDY WOODRUFF: And Dr. Avorn, what is it that you find — you made a comment a moment ago. What is it that you find objectionable about this? What is the problem with it? And what is the change that you see Glaxo making?

JERRY AVORN: Well if I as a doctor want to learn about a drug, I think it’s much better for me to learn about it from somebody who is an expert in the field, but who is not being paid to teach me by the company that is making the product that he is teaching about.

I think it’s much better to have impartial, noncommercial, unbiased sources giving us our information, because that way it’s much more likely to tell us what we need to do to take better care of patients, not to be part of a marketing apparatus to increase sales of a given drug.

And that’s the activity that Glaxo is winding down, and I think that’s a healthy thing.

JUDY WOODRUFF: And, Dr. Stossel, what about this idea that for someone to be paid to explain a drug is — that that in essence is presenting a conflict of interests?

THOMAS STOSSEL: Sure.

Well, first of all, I think Dr. Avorn and I would agree that it’s very hard for doctors to keep up with information. New information is coming in all the time. And so it’s vital that doctors have exposure to as much information as possible.

Now, with respect to the Glaxo move, we don’t really know the details of why they made that decision. I hope they made that decision because they feel they have alternate ways of getting information about their products to doctors.

If they don’t, the shareholders ought to be very concerned and patients ought to be concerned. Now, as far as being paid, well, I think that the institution that Dr. Avorn and I work at pays us, and we and our colleagues go out and encourage patients to come to our institution, but at the same time, we think we give outstanding, objective care.

Now, being paid is an important part of our economy, and the onus shouldn’t be on who pays whom, but on, what is the quality of the service?

JUDY WOODRUFF: So, Dr. Avorn, what about it when you look at it from that perspective?

JERRY AVORN: Well, it is one thing when a doctor is paid to do clinical services for a patient. Everybody knows kind of what you’re doing and what you’re getting and why you’re getting paid.

But to do teaching about a drug, I think it is simply much more messy and distorted than it needs to be to have that education paid for by the company that makes the drug. I’m much more in favor of programs in which doctors can be educated about medications by people who have no commercial axe to grind.

And we have been doing some work along those lines on a nonprofit basis for years. And doctors really appreciate hearing about a drug from a colleague who is not getting paid to read a script, but is just evaluating the evidence as it’s there.

JUDY WOODRUFF: Dr. Stossel, why wouldn’t that — a system like that work?

THOMAS STOSSEL: Well, I should first of all say doctors appreciate hearing from other doctors who are paid by companies, because they voted with their feet, because these so-called peer-to-peer speaking activities have been extremely popular. It allows doctors to learn from other doctors who, whether or not they’re scripted, know a lot about the product in question.

Now, I have no objection to the type of education that Dr. Avorn does. I think should we have all types of education. But we need to understand that, even though it’s nonprofit, he has an agenda to support it. So I return to what I said before. It’s the quality of the information, not the judgments about the motives of the people providing it, that is important.

JUDY WOODRUFF: Dr. Avorn, do you think what GlaxoSmithKline doing is now going to be copied, emulated by other pharmaceutical companies?

JERRY AVORN: I do think they’re setting a good example.

And I wonder whether some of the other companies are going to hang back and see what is this doing to their sales, because you can probably sell more drugs when you can totally control the flow of information than if you just pay a hospital or a medical school to do whatever kind of education it wants.

And it will be very interesting to see whether this is going to cause their sales to take a hit or whether this will be a model that other companies are willing to follow. And we will learn about that in the coming years.

JUDY WOODRUFF: And, Dr. Stossel, do you expect other companies to do the same thing, and do you think there will be an effect on patients?

THOMAS STOSSEL: Well, I hope not.

I think that it needs to be looked at. It’s very important to point out that all — this problem is approached as if it were monolithic, as if one size fits all. But there are all kinds of companies with different product lines. And it’s much more important, for example, in an orphan disease or a cutting-edge area such as cancer that new information about rapidly emerging technologies get to doctors, so they can help patients.

It may be that the Glaxo product profile is not so — it’s not so necessary for them to engage in those activities. So I think — or I hope that, for that health of the industry, that they will react strategically, react to what is in their — the best interest of keeping their research and development programs profitable, so they can take as many shots on goal as possible.

JUDY WOODRUFF: We hear you both.

(CROSSTALK)

JERRY AVORN: I was just going to say, as far as the effect on patients, it could be a better thing if patients are hearing not just about the most expensive, costliest products, but also about good old-fashioned generics that may work perfectly well, but no drug company is going to be paying somebody to go out and teach about that.

So it could make drugs more affordable, which would be a good thing for patients.

THOMAS STOSSEL: Can I respond to that?

JUDY WOODRUFF: And we do…

THOMAS STOSSEL: I mean, the — it’s the urban legend that all new products are more expensive, which, that is true, and that if doctors don’t hear about them, they won’t prescribe them. That is true.

But the idea that old generics are as good as new products is sometimes true, but it is not always true, and that it needs to be viewed on a case-by-case basis.

JUDY WOODRUFF: And we’re going to leave it there. We hear you both.

Dr. Thomas Stossel, Dr. Jerry Avorn, thank you.