Dangerous Idea: Becoming a Squeaky Clean Doctor

Every year as part of the College of Family Physicians of Canada's Family Medicine Forum (FMF), there is a call for abstracts for the Dangerous Ideas Soapbox.

This is the part of the conference during which physicians can share radical ideas for change in primary care. Four abstracts are chosen and presented. The successful ideas are later published in the Canadian Family Physician; see 2015's Dangerous Ideas.

This year, Alan Cassels and I submitted an idea, suggesting physicians completely divorce from pharmaceutical/device industry influence, particularly in medical education.

The idea was quite a dangerous one, particularly surprisingly because the CFP has come under fire (including from Alan) for their own conflict-of interest as far as taking industry money to fund physician continuing education. See: It's time to examine pharma funding of doctors' education - Healthy Debate, and Drug companies wine and dine family physicians - Toronto Star.

Our submission was not successful in the application for the Dangerous Ideas Soapbox, but we share an expanded version of it here for your consideration. 

Our idea: We propose that general practitioners should swear off attending any lectures, CME events, workshops or conferences which are funded, even partly, by those companies and organizations with ties to pharmaceutical and device manufacturers. Even events where the presenters have at least one tie to a pharmaceutical company within the last five years, or is supported by an association that receives funding by the pharma or device industry (including patient and disease groups), would be avoided.  Clinicians and researchers who are working or consulting for, owning shares or patents in, or carrying out speaking engagements on behalf of industry would not be invited to present content to general practitioners. 

How will this work? Physicians’ colleges, professional associations, and university-based continuing education programs would eliminate their dependency on industry-funded speakers, conferences, dinners, workshops and talks. Over time, physicians’ groups would develop their own conference content, invite only independent speakers, and collaborate with organizations that have the capacity for education, without the industry influences. CME credit would not be provided for events in which industry conflict of interest is present. Physicians will have to seek out independent and ‘clean’ sources of information about new drugs and treatments and will more likely rely on independent reviews produced by groups like the Cochrane Collaboration, La Revue Prescrire, and Up-to-Date which all have strict policies around conflict of interest.

Why does this matter? This would drastically change the landscape of prescribing and lead to better and more appropriate treatment, in the best interests of patients and outside the influence of the pharmaceutical industry. Significant harm has been done to patients because of overzealous marketing, off-label endorsement, and the lobbying “machine” of industry which has developed a condition for every medication. Ultimately, with a divorce from industry-tainted education, physicians will increasingly favour treatments that are well-evidenced and most appropriate for the goals of care of their patients. This is likely to be be less costly for patients and the system, and would place increasing emphasis on non-drug alternatives. Also, the image of physicians as “pushers” or “in the pocket of the drug companies” would be reduced over time, enhancing trust from the public.

Why is this dangerous? Physicians have long been part of a system that has allowed the adverse effects of pharmaceutical and device marketing to influence prescribing and patient care. Physician organizations claim they cannot provide education without funding from industry; industry lobbyists argue that interaction with physicians is the only way patients can discover and reap the benefit of new innovations. Some physicians, naive to evidence to the contrary, believe that they are justified in accepting education, meals, and gifts because they (alone) are somehow immune to industry influence. A divorce from industry is not a popular idea, as evinced by the number of physicians and organizations that still feel it is ethical to incorporate this funding into medical education.

The current system is harming patients, but it can be stopped. Those physicians who are concerned that their patients perceive them to be shaped by drug marketing can become “Squeaky Clean” and wear that badge proudly.  

End of Guidelines (Video parody by James McCormack feat. ZDoggMD + friends)

James McCormack (@medmyths, BS Medicine Podcast) does it again!

Clinical Practice Guidelines must change! This is the end of guidelines as we know them.

Yes that is me and Gilbert Welch on the same screen. For realz!

Yes that is me and Gilbert Welch on the same screen. For realz!

We need patient centred care, including discussion of the values of the patient, the harms of intervention, and alternative options. Right now we have a bunch of arbitrary target numbers for treatment that medicalize normal people. These guidelines are mired in conflict of interest as the majority of guideline-authors having egregious conflicts of interest with industry. 

It's time to fix this! I'm honoured to be a part of this effort and call for action. It was awesome fuel for my imposter syndrome being asked to be in one of James' videos alongside some of my 'preventing overdiagnosis' heroes, not to mention ZDoggMD (whose videos I have followed for ages, probably since Hard Doc Life). The video features such like-minded pals including but not limited to: Gilbert Welch, Tim Caulfield, Iona Heath, Victor Montori, Richard Lehman and yep, yours truly - "it's just common sense!"

See for yourself and share widely:

Source: https://www.youtube.com/watch?v=DHDnqQ_mCB...

What Can Patients Do In The Face Of Physician Conflict Of Interest?

I had the pleasure of meeting Dr James Rickert, an orthopedic surgeon and a patient, at the Road to Right Care conference put on by the Lown Institute in March. Dr Rickert works with the The Society for Patient Centered Orthopedic Surgery, advocating for health care reform and patient care that puts the patient in the centre.

One of the topics that he writes and speaks about frequently is conflict of interest in medicine and the financial incentiviazation of care which may be unnecessary or harmful to patients. 

To that end, his most recent contribution to the Health Affairs blog, What Can Patients Do In The Face Of Physician Conflict Of Interest?, describes some the major issues that emerge when caring becomes a business. There are also suggested Action Steps for patients to take when confronting these concerns.

Strong relationships between patients and providers are the heart of healthcare; we must work together to improve our culture and hold providers to a high ethical standard to stop the erosion of trust.

Source: http://healthaffairs.org/blog/2015/04/10/w...