Dr. Drug Rep: Thoughts on Working Too Closely with Pharmaceutical Companies

For a first-hand account of how physicians are working with pharmaceutical companies as speakers -- which I have done extensively in the last several years -- read a very frank one published last week in New York Times Magazine, by Dr. Daniel Carlat: Dr. Drug Rep.

Having had the privilege of meeting Dr. Carlat, I know that he holds himself to a firm ethical standard. You can see that in his article. But I have continued to give talks for a few select pharmaceutical companies, whereas he found the process ethically unacceptable. Am I violating a standard? Am I only fooling myself, to think that I have not?

Linking his essay, I posted the following paragraphs on my website on the page in which I explain how I use pharmaceutical company funding. I'm trying to be quite public about taking money for giving talks about bipolar disorder, to force myself to be as honest as possible about this practice. (Or am I using these posts as another false shield? I don't think so, but I must admit there is no way for me to really know.)

From the website, revised today:
You would have to ask someone who has attended one of my talks to confirm this, but I still think -- after going through the exact same thought process that Dr. Carlat describes -- that I am managing to stay neutral. Oh, I still show the company slides where required, and emphasize (for example) "this is what AstraZeneca wants you to know". But as quickly as possible we move to a discussion of bipolar diagnosis; and when we come around to treatment, I moderate an open-ended discussion in which I try to emphasize treatment approaches with solid, well accepted evidence for their efficacy. I only give talks for companies whose medications meet that criterion, so I am not -- I don't think -- in Dr. Carlat's position.

Indeed, I once gave talks for Wyeth, the company he uses as an example. When they required that I use their slides, as he describes, I declined any further invitations to speak for them. But before that, I did give a talk once for Wyeth in which I found myself promoting Effexor, just as Dr. Carlat did (after the same training experience with Drs. Thase and Sussman, who had a similar influence on me). I had the same feeling he describes: "whoops, I just went over the line". I remember that particular talk vividly (Dr. Robert Burton, a local internist colleague, was there, for example). I still feel guilty about that one. I don't want to have that feeling again.

Dr. Phelps