More transparency needed in experts’ opinions

I HAVE a confession to make. In 1989, as a ‘green’ GP, I enrolled in a post-marketing trial of an antihypertensive agent.

My role was to recruit 20 patients and place them on the medication being trialled.

There was no ‘payment’ but was I provided with a computer modem so de-identified data could be sent in.

There was also a conference where the trial and other topics were presented. GPs were flown to Sydney and put up at a reasonable (not five-star) hotel for a few nights and were fed at a gala dinner.

In these days of transparency it seems amazing to think what went on less than 25 years ago. Yet despite the demise of pens and post-it notes, travel and accommodation have not disappeared for all.

A West Australian auditor general’s report identified gaps in the reporting of ‘gifts’ received by people employed by or associated with the health department. While 15% of these gifts were ‘trinkets’ worth around $25, the rest were flights and accommodation worth up to $16,000.

In 2011, concerns were raised in parliament about the relationship between the WA health department and suppliers. One year later, the auditor general finds “weakness in [WA] Health’s management of free travel and gifts, especially the recognition and management of potential conflicts of interest.”

It is unlikely that WA Health is an orphan.

Meanwhile, a BMJ report has been scathing on post-marketing trials as being more about enlisting doctors and, in turn, patients and less about genuine research.

And in an interesting editorial in Australian Prescriber, Professor Leon Flicker of UWA raises the thorny issue of opinion leaders and their influence.

What are the connections here?

While we doctors tend to think we are above influence, it is human nature to be well disposed towards someone who has flown you around the world at the front of the plane and put you up in a flash hotel. It is also likely you will be receptive to information provided to you and may not ask difficult questions in your position as a ‘guest’.

So while GPs get pilloried over a 10c pen, some of our specialist colleagues live high on the hog. Would it be interesting for GPs attending a talk to know how much Professor Blogs receives in consultancy from the talk’s sponsor? And might knowing this affect how the information provided is viewed? The answer to both questions is yes.

More importantly, the doctors chosen for these invitations and to give talks are likely to be seen as being ‘onside’ to start with. Daniel Carlat, an American psychiatrist, describes in his book, Unhinged, his experience as an opinion leader. He gave numerous talks for companies. However, as soon as he deviated from the company line (which he was never “forced” to use), he was removed from the speaker roster.

So is it wrong for doctors to work for industry? The answer is no. Does there need to be a separation of church and state whereby those paid by industry are not in a position to decide on government (or other) contracts related to companies they work for? Do we need to know who pays the piper when expert information or opinion is offered? The answer to both is absolutely.

As it turned out, I took most of the patients off the trial medication, as it didn’t work that well. But I suspect the scripts written covered my costs.

And when it comes to opinion leaders in medicine, perhaps we should recall Dirty Harry’s line in The Dead Pool: “Opinions are like assholes. Everybody has one.”
Dr Joe Kosterich
GP, Woodvale, WA
www.drjoe.net.au