Eyeworld

OPHTHALMOLOGY BUSINESS 74 August 2016 by Liz Hillman EyeWorld Staff Writer that dinner, it doesn't mean he is biased. It could be the physician received more education about a specific condition and how that medication could be beneficial. It could be that the brand name product is actually cheaper than a generic based on the patient's type of insurance. Not to mention, Dr. Trattler said he doesn't think a single doctor writing prescriptions for a certain type of medication is going to have a significant impact on a company's bottom line. "I don't see companies reward- ing those who are higher prescrib- ers," Dr. Trattler said. "My colleagues and I just try to do what's best for patients because that's how we are able to help our patients." Richard Hoffman, MD, Oregon Eye Specialists, Eugene, Oregon, said in many cases he thinks the relationship between industry and ophthalmologists is not ethical. It is, he said, most often a relationship used to promote products, rather than improve them. "I was involved with doing some marketing work with industry back in the early 2000s, late 1990s … doing promotional speaking, primarily for the makers of anti- depressants," said Daniel Carlat, MD, associate clinical professor of psychology, Tufts University School of Medicine, Boston, who has a par- ticular interest in the topic of con- flict of interest between physicians and industry. "I worked closely with industry representatives, and I was paid quite a bit of money for giving lunch-time talks to other doctors, and I found myself hyping up the benefits of a drug and downplaying the disadvantages." Dr. Carlat said after about a year of doing these kinds of presenta- tions, he became uncomfortable and stopped. "There is a benefit to some industry relationships, particularly when they are focused on scientific development and medical innova- tion," Dr. Carlat said. "The relation- ships I'm more concerned about are the ones that are strictly marketing, like being promotional speakers or spokespeople for certain products. Those kinds of interactions are far more valuable for the company than for the patients." require the experience of physicians to help develop new ideas and guide them to areas that are important and impactful. As physicians have the benefit of daily and direct inter- actions with patients, we are able to best advise of their needs and how the medical industry can help in a positive way." If physicians are not involved with industry, Dr. Trattler said, the treatments developed might not address the actual needs of patients. Unfortunately, Dr. Trattler thinks that the physician/industry relation- ship is at times demonized by the lay press. "Industry has worked very hard to make sure that physician/com- pany interactions are ethical," he said. "Unfortunately, in the effort to provide complete transparency, the medical industry has committed to providing an exceptional amount of detail. This results in a significant cost to the pharmaceutical and de- vice industry, as they have to report on even the smallest level of giving. For example, the reporting of a cup of coffee that was given at a meeting where there is funding by industry is unnecessary, since many times the doctor will not know which compa- ny helped fund the coffee. I think that this level of reporting is over done." He gave another example of a physician attending an educational dinner hosted by a pharmaceutical company. Dr. Trattler said if a phy- sician decides to prescribe a brand name medication after attending partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions." 1 William Trattler, MD, Center for Excellence in Eye Care, Miami, sees a strong benefit in industry and clinicians working together. "I think a main focus of indus- try is to be innovative with the goal of developing new medications, devices, and technologies to help our patients," Dr. Trattler said. "Without innovation, we will not develop new treatments for cancer, macular degeneration, glaucoma, and so many other serious diseases. These innovations have the poten- tial to significantly alter the course of these diseases that are life threat- ening or life changing. Companies working on new technologies can- not develop them without physician involvement. These companies Working with industry can be a boon for patients, but conflict of interest remains a cautionary point A n ophthalmologist agrees to help a pharmaceutical company design a clinical trial. Another consults with a device manufac- turer, providing insights to improve a new product. Another speaks at a corporate-sponsored continu- ing medical education luncheon. Another meets with a drug represen- tative in his office. And the list of examples as to how physicians and industry can work together goes on. Most agree that patients, in the end, can benefit from some of these relationships. Working with device manufacturers or pharmaceutical companies gives physicians the opportunity to have input on the types of medications or therapies that could be beneficial to patients and the tools that could be useful to them in the OR, improving out- comes. Inevitably, there can be situa- tions where the patient's best inter- ests might not be the primary goal of such relationships. As Susan Coyle, PhD, wrote for the American College of Physi- cians–American Society of Internal Medicine Ethics and Human Rights Committee in a position paper in 2002, "Physicians and industry have a shared interest in advancing med- ical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although Industry relationships: Striking the right tone continued on page 76 Tips for working with industry • Seek industry relationships that improve products and therapies, don't sell them • Address colleague concerns • Consider publishing your professional relationships in case patients ask • Always put the patient first

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