by John Steinberg, DPM PRESENT Editor Assistant Professor, Department of Plastic Surgery Georgetown University School of Medicine

If Doctors Don't Police Themselves,
the Police Will

A tidal wave of new regulation has come to healthcare over the past several years.  One key area that has come under the microscope has been that of pharmaceutical and device marketing. As you have likely noticed, there is no longer any 'logo' merchandising (i.e. pens, note pads, or mugs) brought to your office or hospital. The days of ball game tickets and skyboxes are quite far behind us now...and much of it with very good cause. But, has the pendulum swung too far? Are we being policed by government and societal agencies as if we are villains? Isn't it the American way that the hard working and better represented company should be allowed to succeed? Shouldn't capitalism and free market society rules apply to healthcare pharmaceuticals and devices, or is it somehow wrong to try and 'sell' something to the healthcare market? I can see some good arguments on both sides here.

Clearly, we brought some of this upon ourselves. Medicine is well known for failing to police itself and failing to deal with the few 'bad apples' that can make things spoil for all of us. In fact, the alphabet soup that now is watching over this topic of medical marketing regulations has expanded to include FDA, CMS, OIG, FBI, PhRMA, AdvaMed, AACM, ACGME, and ACCME, to name a few! The major group that impacts the pharmaceutical world is the PhRMA organization, which is a professional organization that stands for "Pharmaceutical Research and Manufacturers of America". PhRMA group has updated its Code on Interactions with Healthcare Professionals for January 2009 and this is indeed where the NO MORE PENS came from.

In part, these professional organizations have become strict in their guideline language in an effort to prevent the government from legislating a solution to this problem. Many physicians and companies committed gross abuses and fraud/corruption in what amounted to physicians/surgeons being bribed to use their product. At this point, groups like PhRMA may have a strong impact, but they rely on voluntary compliance from their member companies, and have no influence over companies that are not members of their organization.

To achieve a proper balance can be a challenge. Our medical research and education system is set up to be somewhat dependent on corporate support. As an academic physician, I perform research funded by grants from manufacturers, I give lectures on topics at CME meetings that include many of the latest technologies in drugs and devices, and I help to educate medical students and surgical residents who work closely with the company reps in the hospital. Each of these activities has the potential to be fraught with conflict if not managed properly. Directed efforts must be made to keep business interests of corporate entities at an arms length. Much of our continuing medical education structure has become dependent on industry support in order to keep costs reasonable to the practitioner, who is required to attend. The PRESENT online educational system has depended on generous corporate support, in order to make their lectures and ezines available to us at a reasonable cost. They have now lowered their standard price to $20 per lecture, in order to make it even more affordable to us. From having helped organize and run many CME meetings myself, I can safely say that tuition would have to at least DOUBLE if corporate support was withdrawn from our conferences.

So where do we go from here? I would love to hear your feedback and thoughts on this issue. What direction would you like to see us take on this and how do we ensure that we do not slide back into the mistakes of the past? I look forward to hearing from you!

Sincerely,

John Steinberg, DPM
PRESENT Editor
Assistant Professor,
Department of Plastic Surgery
Georgetown University School of Medicine
[email protected]

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