Wednesday, November 10, 2010
White Coat Syndrome
“Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs,” begins an article at Pro Publica that is the highlight of the second installment of bad behavior week.
“But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.”
Maybe I was a cynical little kid but I can clearly remember the first time I saw a TV doctor pitching a medical product. He was that guy from the show Emergency and, even though I was a little kid, I turned to my sister and said, “That’s guy’s not a real doctor. Who would believe this?” But as the years rolled by my wide-eyed wonder turned to pure cynicism as someone in a white coat would inevitably turn up whenever something of perceived medicinal value was being peddled on the telie. Apparently, if one donned a white coat they were immediately exalted as experts in, well, whatever happened to be the subject matter at hand—you know, like the Professor on Gilligan’s Island.
But then something weird happened. These hucksters stopped looking like Kelly Lynch in Road House and began to resemble the people I’d see down at the medical clinic. Were REAL doctors actually doing ads for products ranging from cold medicines, to gum, to cigarettes? And, if so, why? I’d always thought doctors made enough money that if you wanted an appointment on Thursday you needed to secure an early tee time.
As it turns out, not surprisingly given they are human, not all doctors are good at their jobs. But instead of failure leading to finding a new career path that better suits them, doctors can now parlay their vocational failure into sometimes even more lucrative: careers as spokespeople.
A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.
Yes, today’s bad behavior post is about doctors, but the real people behaving badly are those who are doing the hiring; in this case the Pharmaceutical companies. Perhaps instead of revoking their medical licenses the AMA should forbid bad doctors from wearing white coats in public.
In the case of Big Pharma, I suppose it’s easier to coerce a disgraced doctor to pitch your product, especially if it’s for something that’s ethically on the fence.
In 2001, the U.S. Food and Drug Administration ordered  Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.
Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.
A little ethically shady, to be sure, but hardly cause for some high scale investigative reporting. However, some Pharma’s source from grayer areas, apparently the darker the better:
And in Georgia, a state appeals court in 2004 upheld  a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.
Last year, Taylor was Cephalon's third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.
The article, part one of a series, then goes into depth about some of the seediness in the industry, including active recruiting of non-qualified doctors to “educate” or, in reality, pitch their products.
“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”
And it’s all, of course, in the pursuit of the almighty dollar.
"The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”
Can you blame them? Um, yes. You can. At least by nominating them people who behave badly for the day.
pic: egregious "pain don't hurt" road house shot. how can you not love a doc whose white coat covers her mini skirt, who digs ass-kicking zen bouncers, and monster trucks? god bless america. i thought you'd be bigger.