RELATIONSHIP STATUS: IT’S COMPLICATED

The operative word describing the relationship between pharmaceutical companies and physicians is“complicated”.  These companies are responsible for innovative medicines, including cancer therapies providing hope to patients where none previously existed.  For example, when I started nearly 15 years ago very little could be offered to prostate cancer patients when hormonal therapy failed.   In the last 6 or 7 years there’ve been at least 6 new therapies that can be used now.  This theme has been seen duplicated in numerous other cancers including urological kidney and bladder cancers.

Nevertheless, in clinical spaces where choices exist, these companies exert their influence by seeking financial relationships with physicians in hopes their drug will be the preferred choice.  There is a natural conflict of interest the results when physicians are paid large sums of money by these companies.  As a result, Congress passed the Physician Payments Sunshine Act in 2010 as part of the Affordable Care Act, which forced Big Pharma to disclose payments to physicians as well as large teaching hospitals.  This database is widely available on the Internet for all to see.

These companies clearly leverage their positions and relationships with physicians and medical practices to make lots of money.  However,  pharmaceutical companies are among the most charitable corporations.  Of the 20 most charitable companies in the Fortune 500, 3 are pharmaceutical companies.  These companies fund projects in developing nations such as medications for HIV, hepatitis and vaccinations, and have grants available here in the United States for cancer patients unable to afford their medications (particularly for new advanced therapies which routinely cost tens of thousands of dollars per month)

Even in charity there has been criticism as the charitable calculations (and therefore tax write-offs) are often made by the commercial value of these drugs, and the cancer grants that are used to pay for these drugs invariably get funneled back into the companies.

Likewise, the ethics of physicians who partake in these relationships may well be scrutinized.  Certainly physicians who are thought leaders may want to leverage their status and position for financial gain, much like an elite athlete who signs a lucrative endorsement deal (think Michael Jordan and Nike).  However, the doctor-patient relationship has historically been viewed as a sacred trust; hence, any outside influence particularly, a financial one, undermines this relationship. Relationships between doctors and pharmaceutical companies come with some implicit understanding that they their drugs and products will be favored over others.

My own feelings toward pharmaceutical companies are equally conflicted.  I do not have any financial relationship with these companies as it does erode the ethics of our field.  However, my group does allow doctors to partake in financial relationships with companies, allow these companies to come to our office, providing lunch and access to influence providers, and take samples from these companies, including many expensive cancer drugs.  Personally, I try to partake in as little interaction as possible thereby minimizing potential influence in patient care.

However, these companies do provide grants for Urology Teaching Day (a yearly program where many world renowned experts come to lecture, a collaborative effort between Premier Medical Group and Vassar Brothers Medical Center) thereby bringing experts to our area that can help us improve patient care. They also sponsor our yearly Prostate cancer awareness walk (Walkway over the Hudson, in September, done by Premier Cares Foundation, which raises money for patients who can’t afford their care), which is another excellent cause. Neither of these events would be as successful as they have been without their support.

In the end, intentions and ethics matter most, and as a physician I can have a meaningful interaction with this industry to help our patients and community without seeking personal gain or fortune. Unfortunately, our industry is ripe with headlines of doctors who have abused their position. (https://nypost.com/2017/05/02/urologist-pissed-away-2m-in-company-funds-suit/. https://www.nytimes.com/2018/09/08/health/jose-baselga-cancer-memorial-sloan-kettering.html?action=click&module=Top+Stories&pgtype=Homepage&fbclid=IwAR3n-l_6_RZL53RwJNVhVcX6mgSt4IImCpGW_3FnpiRbyIqGrssv-OfNrAs

 

Relationship status: It’s complicated!

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