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WHY I BECAME
A DOCTOR
‘I didn’t go into medicine for that!’
By Jeffrey Meffert, MD
There are many reasons to seek a career in the medical profession. are options to clear the smoke and make more plain whether
To get rich is not a good one, and there are easier and shorter routes your speaker is just an expert who had the time to tell you what
to riches than medical school, residency and years of practice. On is really new or a KOL who really should be more properly con-
the other hand, some of our colleagues are doing better than you sidered an over-educated (and overpaid) pharmaceutical detail
might think. representative.
Of the following, which drug do you think has the SMALLEST An excellent website worth consulting before you head to the
marketing budget: a revolutionary new oral medication that allows “educational program” at a local steakhouse is Dollars for Docs
you to treat hepatitis C without the discomfort and misery of in- (http://projects.propublica.org/docdollars/). You key in the
terferon, an injectable biologic treatment for arthritis that has been speaker’s name, and you not only will find out how much they are
available for over a decade, or a new “oral biologic” that has close getting from the pharmaceutical industry but how much specifi-
to a 50 percent side-effect rate and on its best day is slightly better cally from this meeting’s sponsor. Sometimes you need to check
than placebo? The answer is the first medication described because, other versions of someone’s name (Ted vs. Theodore) to get the
to some extent, it will “sell itself ” and big budget advertising isn’t whole picture, and you usually will have to use the speaker’s first
necessary. name even if they go by their middle name.
The highest marketing budgets go to “me too” medications You also can search by facility name if you want to see how much
which have stiff competition with other products in their class and a research organization or a medical school is getting from industry.
to medications which are not especially effective when used in your Not all companies participate in the program yet, and it seems to
clinical practice. That is because marketing is meant to convince be months between updates so not every dollar spent is reported.
you, the prescriber, to give their product a go, and to tell you that There are state and national laws coming into effect that will con-
even if the efficacy is not great and even if there are other effective tinue to make this industry-physician economy more transparent
and cheaper alternatives, this is something your patients need and and accurate reporting a requirement for doing business.
want. Part of that marketing, occasionally billed under the expen-
diture category of research and development, is the employment of SHOWING GRATITUDE
your fellow physicians and key opinion leaders (KOLs) in your spe- This is not to say that just because a speaker gets $20,000 or
cialty to write the articles, develop the practice guidelines, give the
seminars, and appear at your local society meetings to sing the $30,000 a year from Company X that they will necessarily be
praises of the “latest and greatest.” telling lies on behalf of the product. Some of your speakers may
have been researchers who developed the product and may feel
CONFLICTS OF INTEREST quite passionately about the value of the treatment.
Anyone who reads their journals for the latest practice guidelines
On the other hand, it must be recognized that we are taught from
must first wade through at least a page of stated conflicts of interest. birth to show gratitude for what we are given. If one is not legally
Every acknowledged KOL has taken some money some time from required to mention those pesky negative studies (and they aren’t
industry. It is the rare industry-sponsored meeting that can make included in my pre-packaged slideshow), why would I do so? I also
any claim to represent unbiased continuing medical education, and might gloss over side effects that don’t rise to the severity of “black
most are now done by consultants who have a company-prepared box” warning, even if they are going to afflict dozens or hundreds
PowerPoint presentation that, if they are to be paid, must be pre- of your patients.
sented exactly as it is put together with all the graphs, charts and
data that will tend to make your eyes glaze over as you enjoy that Also, if I am being paid thousands to talk to you over a steak and
steak dinner. These presentations give you the message that, a glass of wine, I might forget to make sure you really understand
whether this is a new product or an old one that has been slightly that if the product shows 50 percent improvement and placebo
reformulated and repackaged, this is what you should be using if shows 35 percent improvement, that the true efficacy is only 15
you really care. percent. I’m only human, right?
Until recently, there was no way to tell how beholden your Jeffrey Meffert, MD, is a dermatologist at the Univer-
speaker was to the company picking up the tab, but now there sity of Texas Health Science Center San Antonio.
22 San Antonio Medicine • May 2015
