Published Monday, September 21, 2009

It's now clear that the pharmaceutical industry that claims its goal is to improve lives is just as likely as any other industry to manipulate the truth to make a buck. Even more disturbing: Drug companies have found a stable of doctors willing to help them in exchange for cash or prestige. Doctors should know better, particularly those affiliated with medical schools, and the medical schools should adopt stricter rules.

Recent disclosures, forced by court cases or federal regulators, have laid bare the complicity of doctors, including some in Tampa Bay, in helping drug companies sell their products. Experts estimate for each $1 spent on such marketing, companies reap $12 in increased prescription sales. When doctors receive thousands of dollars from drugmakers to help deliver their message, it creates an inherent conflict of interest with their primary job: Caring for their patients. Medical schools should be attacking this ethical problem directly, particular in an era when costs are leaving many uninsured.

Some schools, such as Harvard and Stanford, have banned the lucrative relationships. Short of that, medical schools should at least require strict reporting and public disclosure, with serious consequences for lapses. That hasn't been the case in the past at the University of South Florida College of Medicine.

The St. Petersburg Times' Kris Hundley reported on Sunday how drugmaker Wyeth for years paid for and influenced the ghostwriting of medical journal articles and continuing education conferences in an effort to boost sales of its hormone treatments for menopause. The campaign continued even after a federal study indicated the drugs might make it harder to detect breast cancer in patients. Dr. James Fiorica, then a professor at USF and head of the gynecologic oncology program at H. Lee Moffitt Cancer Center, was among those who participated. He chaired a Wyeth-backed conference and signed his name to two ghostwritten articles. He, like other doctors earning money from pharmaceutical companies, said he never signed his name to a position he couldn't scientifically defend.

And last month, Hundley wrote about Eli Lilly & Co.'s program that paid physicians tens of millions of dollars in the first quarter of this year to talk about its drugs. One of Lilly's highest paid physicians and its top earner in the Tampa Bay area is Dr. Maria-Carmen Wilson, a neurologist and USF professor who is director of Tampa General Hospital's Headache & Pain Center. She was paid $54,400 in the first quarter of the year for speaking with fellow doctors about Lilly's Cymbalta drug on 27 occasions. Wilson reached Lilly's annual cap of $75,000 in May.

Nonetheless, Wilson failed to follow USF policy to get prior approval before making presentations on behalf of a drugmaker. Wilson also failed to inform USF when she took free trips to Scotland and Spain for drugmaker Astra-Zeneca. Last month, USF approved Wilson's Lilly activities retroactively.

Another USF-affiliated physician, Dr. Brian Keefe, also failed to disclose earning $15,000 from Lilly in the first quarter.

In April, USF medical school announced new reporting guidelines for interactions between faculty and drug- and medical device makers. But it seems the message has not gotten through, and faculty who ignore the rules are retroactively given a pass.

USF's answer is that more clarity is coming. Dr. Stephen K. Klasko, CEO for USF Health and dean of the College of Medicine, says he has convened a group to look at all faculty relationships with pharmaceutical companies in order to make new rules and reporting requirements "as simple and as consistently enforceable and as clear as possible."

"We're going to have a zero tolerance policy," Klasko says.

That can't happen soon enough. Patients rely on doctors to give them the best treatment possible, not just the treatment they're paid to support.