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October 27, 2009

Milwaukee Journal Sentinel: Doctors’ Presentations Help Patients

Today’s Milwaukee Journal Sentinel includes an editorial by Thomas Stossel, MD titled Doctor’s Presentations Helps Patients.   The editorial is in response to a series of articles and editorials in the newspaper critical of physician industry collaboration. 

Despite arguments to the contrary, doctors should be paid (Editorials, "Get off the gravy train," Oct. 7). They should be paid to bring specialized knowledge and experience to their patients. They also should be paid to bring specialized knowledge and experience to their colleagues.

Both exchanges create value and improve patient health. Hollow accusations should never obscure this fact. Promotional presentations by physicians should not be banned; they should be celebrated, for patients' sake.

Medicine, although rooted in science, is still an art. Ask any physician. And like every art, mastery comes from experience, not from simply reading manuals. Physicians are no different from other artists.

They need more than voluminous texts to practice their art. They need to hear from colleagues who have real-world experience with the medicines, devices and diagnostic tools that provide the foundation of modern medical care. Banning promotional presentations, where a presenter and the audience are allowed to engage in free and open dialogue about the benefits and risks of medical products, limits the opportunities to exchange these experiences.

The Journal Sentinel Editorial Board claims that when physicians promote products, "they risk their credibility with patients, risk clouding their judgment, risk overusing a treatment and risk driving up the cost of medicine." Everyone can agree that these risks do exist - nothing in life is without risk. The more important question, however, is whether these risks translate into harmful behaviors or consequences to patients? The resounding answer is no.

Polls repeatedly show that physician credibility is based on the care they provide, not the sources of information they access or how they educate their colleagues. Moreover, there is near consensus that non-financial factors such as gaining tenure, publishing and climbing the academic hierarchy are much more likely to prompt unethical behavior among academic physicians, who represent the majority of promotional speakers. These influences require much closer examination.

Of even greater importance, however, is how these activities affect patient care and patient health. Contrary to what critics would have us believe, under-treatment due to limitations in physician knowledge and experience is more detrimental to patient health and more likely to drive up costs.

Take diabetes as an example. The prevalence is skyrocketing, its causes and consequences are well understood and treatment options are many. Nonetheless, under-treatment is the rule, rather than the exception.

Although 71% of diabetic patients have high blood pressure, less than half get sufficient treatment to reach treatment targets. Failures such as these impart enormous costs on the quality of life, productivity and our nation's financial health. Severing physician interactions only contributes to these unnecessary costs.

The University of Wisconsin has a rich history of leadership in the medical field, and it has the opportunity to continue to lead. We hope it will foster a culture that values exchange of information and experience and puts patients back at their rightful place as the focus of medical policies.

Thomas P. Stossel, M.D., is ACRE co-founder and executive committee member, an American Cancer Society professor of medicine at Harvard Medical School, director of the Translational Medicine Division at Brigham & Women's Hospital. He is a founding scientist and director of Critical Biologics Corp. and a director of Velico Corp. He has contributed his views on physician-industry collaboration as a consultant to Merck, Pfizer, Amgen, Bristol-Myers Squibb and IMS Health.

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