Healthy Skepticism Library item: 17096

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Publication type: news

Kowalczyk L
Doctor quits Brigham to speak for pay
The Boston Globe 2010 Jan 23
http://www.boston.com/news/health/articles/2010/01/23/doctor_quits_brigham_to_speak_for_pay/

Full text:

Boston physician Lawrence M. DuBuske was given a choice: Either stop moonlighting as a paid speaker for pharmaceutical companies or quit his job at a top Harvard teaching hospital.

To the surprise of some, DuBuske, an allergy and asthma specialist and a Harvard Medical School instructor, will resign from Brigham and Women’s Hospital at the end of the month, the hospital said.

DuBuske is no ordinary speaker. Out of thousands of US doctors hired by drug-maker GlaxoSmithKline to talk about its products, he was the highest paid during a three-month period last year, the company recently disclosed: He made $99,375 for giving 40 talks to other physicians last April, May, and June, almost one every other day.

DuBuske seems to be everywhere, with recent speaking stops spread from Boston to Buenos Aires, Poland, and Russia. Six other pharmaceutical companies also use him as a speaker, and he is a consultant for a half-dozen drug makers, according to information he disclosed while teaching continuing medical education courses. The disclosures did not mention how much he was paid for this work.

But DuBuske’s extensive speaking for drug companies is now in direct violation of a strict new conflict-of-interest policy for the Partners HealthCare hospital network, which includes the Brigham. So he is leaving after more than two decades at the hospital. As a result, Harvard will also terminate his appointment.

’’There are physicians earning so much money [from drug makers] that they would give up their jobs,’’ said Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic Foundation. “It’s a shocking story. Normally you’d give up the [pharmaceutical company] honoraria.’’

DuBuske did not return phone calls from the Globe. But his situation shows both the significant amounts of money doctors can make moonlighting for pharmaceutical companies and the potential impact of the growing restrictions on industry ties at teaching hospitals.

Christopher Clark, director of Partners’ Office for Interactions with Industry, said that since the policy banning doctors from participating in speakers’ bureaus went into effect on Jan. 1, one other doctor, from McLean Hospital, has resigned at least partly because of the rules. Partners declined to identify that doctor.

DuBuske is employed part time by the Brigham, seeing patients between a half-day and two days per week.

“He made a decision between terminating the relationship with Glaxo and terminating his relationship with the Brigham, to do the latter,’’ Clark said.

In addition to seeing patients at the Brigham, DuBuske, 55, runs a Gardner-based nonprofit organization called the Immunology Research Institute of New England, which sponsors education programs for doctors in Eastern Europe, according to its website.

He speaks Russian, has published dozens of articles, and in 2004 won the Distinguished Fellow Award of the American College of Allergy, Asthma and Immunology, according to his and the Brigham’s websites.

His work for Glaxo came to light last month, when the company posted on its website a list of physicians it paid for consulting and speaking during the second quarter of 2009.

Mary Anne Rhyne, US director of media relations for Glaxo, said DuBuske is a national speaker for the company, earning about $2,500 per talk. The company picks the topic and content of the talks in the speakers bureau program, she said.

Rhyne said she is not sure whether DuBuske will be as much in demand as a speaker without the prestigious Brigham and Harvard titles.

“A lot of things would go into a decision about that,’’ she said. “Most of all, we’re looking for people who are well respected.’’

As more teaching hospitals restrict or ban participation in speakers’ bureaus, physicians said, it is unclear whether drug companies will cancel talks or turn to doctors without academic appointments, who are outside the rules but may not draw as big an audience of fellow physicians.

“Why is it a physician can command that kind of money from a pharmaceutical company?’’ Nissen said. “It’s often because they hold a prestigious title. Harvard and the Brigham, those are tangible assets that are worth a lot.’’

Several other hospitals and medical schools – including Stanford, considered to have some of the toughest conflict-of-interest rules in the country – said they have not yet seen doctors resign over their policies.

These policies, which usually also prohibit doctors from accepting gifts from drug companies, aim to counter the industry’s influence over the drugs and treatments physicians prescribe. Politicians, regulators, and some physicians are concerned that doctors who give company-sponsored talks may present biased information that could underplay harmful side effects or may encourage use of expensive brand-name medications instead of less costly alternatives.

But physicians who participate in speakers’ bureaus say they carefully screen the information for accuracy, and some doctors argue that working for numerous companies, as DuBuske does, cancels out bias in favor of any one drugmaker.

But Dr. Paul Appelbaum, director of psychiatry, law, and ethics at Columbia University College of Physicians and Surgeons, said he worries that “someone who takes money from all companies is not in a position to say anything critical about any of their products.’’

It is possible to take money from a pharmaceutical company and deliver an unbiased talk, he said, but it is risky because bias can be so subtle. The speaker could define a condition requiring medication more broadly than is appropriate or encourage treatment sooner rather than later.

“This may or may not be good for the patient,’’ he said. “It’s difficult for the audience to ascertain if there’s bias, because they’re not the experts. They’re coming to hear someone who knows more than they do.’’