A complicated web: Industry relationships raise concerns, derms say

March 1, 2008

It's time for dermatologists to realize the many ways in which accepting industry support can compromise patient care, an expert says. Despite mounting financial pressures, accepting industry support remains a matter of choice, he says.

Key Points

San Antonio - The influence of the pharmaceutical industry on dermatologists is more pervasive than many doctors may think, says John Voorhees, M.D., chairman, department of dermatology, University of Michigan, Ann Arbor, Mich.

Dr. Voorhees discussed relationships among academia, organized dermatology and industry during a session on "Hot Topics in Dermatology" at the 66th annual meeting of the American Academy of Dermatology here in February.

Corporations are influencing dermatologists and their organizations with money, gifts and money surrogates, such as unrestricted grants, he says.

Although such grants theoretically come with no strings, he says, the endeavors they support rarely, if ever, reveal bad news.

"Many studies show that we're all influenced by subtle things, because none of us would ever admit" to being obviously influenced by industry financial contributions, he says.

Nevertheless, one reason dermatologists continue to rely on industry support is that they tend to want more services from their professional organizations, but continually reject dues increases.

Some dermatologists rationalize their behavior by saying other physicians and organizations are accepting industry contributions, Dr. Voorhees says.

"I've heard many times that the cardiologists, psychiatrists and gastroenterologists are far worse than we are. But that doesn't mean we're OK," he says.

Accepting industry money tarnishes the profession of dermatology, he says.

"We've breached our societal contract with patients. We talk about putting patients first. But there are many times, as far as I can tell, when patients are not first," Dr. Voorhees tells Dermatology Times.

The upside

On a positive note, he says manufacturers have produced "some good drugs and a few good devices. I say 'a few,' because the way the device companies do studies or don't do them is sufficiently flawed that there is very little reliable information about what's a good device."

Dermatologists need drug, device and cosmetic manufacturers, Dr. Voorhees says.

"And most, if not all, of the (representatives) I've interacted with are honest, good people," he says. "The question isn't whether we need to work with them, but how we're going to do it."

In this regard, he says speakers' bureaus top the list of involvements he considers "dodgy" - particularly when dermatologists rely on manufacturer-supplied slides.

"A speakers bureau member becomes a marketing agent for a corporation. The person is now a member of a surrogate sales force. That's not a great way to build a reputation," Dr. Voorhees says.

Nevertheless, he says that in an era of declining reimbursements, the prospect of pocketing $1,000 to $10,000 per speech - and sometimes traveling by private jet - proves too powerful for some physicians.