I love the way Frank J. Veith, MD, professor of surgery, Department of Surgery, NYU Medical Center, New York; and professor of surgery, Cleveland Clinic Foundation, lays out the reasons why commercial support isn’t actually the devil in this article on Medscape. I particularly like this line: “Perhaps congressmen, state legislators, and others who are so eager to prevent even the appearance of financial conflict of interest between doctors and industry should first apply the same standards to their own relationships with their financial supporters.” Hmm, I think I made the same suggestion not too long ago.

Anyway, it’s a good argument toward, as he says in the headline, fixing the relationships, not severing them.

According to an article in the current issue of the Archives of Internal Medicine, while almost 84 percent of respondents to a survey said they had some sort of relationship with industry during the previous year, this is 12 percent fewer than was reported in 2004. The areas explored included drug samples, food and beverage, expense reimbursement for trips and CME activities, and speaker fees.

While there’s a fee to read the full paper, here’s a recap of some of the findings on DOTmed, and here’s USAToday’s take on it. John Mack over at the Pharma Marketing Blog had an interesting take. He notes the “sharp drop in % of physicians receiving payments for consulting, participation on speaker bureaus and advisory boards, and for enrolling patients in clinical trials. That percent decreased from 28% in 2004 to 14% in 2009.” In addition to the usual reasons for the drop—that organizations are cracking down on these relationships, and that it’s due to the physician payment disclosure requirements some pharma companies have to follow now due to legal settlements, and all will have to follow once the Sunshine Act fully kicks in–Mack thinks it might also have to do with “the decreasing number of new brand name drugs coming to market in last several years.”

I know, stop the presses, right? The Boston Globe is continuing to delve into the relationships between physicians and pharma with a series of stories beginning on today’s front page about which docs are being paid what to serve on pharma speakers bureaus. Not surprisingly, Harvard Medical School docs scored the motherlode for Massachusetts, having received 45 percent of the $6.3 million this year and last by the companies that are posting payments publicly for at least some of that time period (the payments also were for research and consulting, in addition to serving on speaker bureaus).

Here’s another related article from today’s Globe: Doctors with questionable records earn a lot as drug firms’ speakers. It’s kind of strange to see the two together, I thought. (Here’s a longer version on the site of ProPublica, which developed the database all this is spinning out of. Lots of interesting info to go through, including a state-by-state breakdown, here.)

If you think this is a feeding frenzy, just wait until the Sunshine Act kicks in in 2013 and all pharma companies will be required to report all per-physician spending of more than $10.

P.S. Here’s the Chicago version, via the Chicago Tribune: Watchdog: Dollars for Doctors. This one is interesting — they asked the 25 docs who make the most from pharma speaker bureau gigs to comment on their activities.

Update: And here’s the Denver version. I was talking with someone today about this, and they thought no one else was picking up on this story. My take was that reporters all over the country are madly crunching their state’s numbers. I’m guessing there will be 47 more of these coming in the next few days.

The state of Massachusetts (where I just so happen to live) has one of the strictest policies of any state around the interactions between healthcare providers and pharmaceutical companies. Earlier this week MassBio hosted the 2010 Gubernatorial Candidates Forum, featuring candidates Charlie Baker, Tim Cahill and Governor Deval Patrick, who debated the Mass. gift ban, among other topics. Here’s the gift ban clip:

It sounds like all three — including Governor Patrick, who backed the ban initially — think it needs to be either modified or outright removed. Then again, candidates say all kinds of things during an election cycle, and it can vary depending on the audience. We’ll have to wait and see what happens with this one, but if it did get weakened or eliminated, it would be the first step backward in pharma-HCP-interaction regulation I’ve heard of in recent years.

Mark your calendars: September 10th is the day Pfizer’s Medical Education Group is putting on a free hour-long webinar (11-noon Eastern) that will include a review of the company’s grant processes, a session on social media and CME with Brian McGowan, PhD, and a Q&A session at the end. Be sure to read Dr. McGowan’s excellent (IMHO) articles on social media ahead of time:

The Great ASCO Tweetup

The Alliance for CME and Social Media

You do have to pre-register, but it only took me about 30 seconds. Participation will be limited to the first 1,000 to register, so sign up now if you’re interested. MEG also says to go ahead and submit any specific topics you’d like to have covered and any questions you’d like to have answered via e-mail.

Here are two interesting perspectives on industry/HCP interactions, including the commercial support of CME:

Appetite for Instruction: Why Big Pharma should buy your doctor lunch sometimes, by Jessica Wapner at Slate.com

Bought and Sold: Who Should Pay for CME, by Mark Crislip at Science-Based Medicine

Check out this video by Medical Meetings columnist and president of Global Education Group Stephen Lewis, who points out a bright side of the otherwise fairly dismal information in the 2009 ACCME data report:

Like most, I was riveted by the pretty startling drops in commercial support and total income, and didn’t think to look at per-HCP costs. Funny how different people bring different perspectives to the same set of data, isn’t it?

But it gets me wondering why the per-HCP cost is decreasing. Is it because of the type of activities (i.e., Internet-based activities instead of live courses)? More HCPs per activity? You’d think it would be increasing, since the cost of everything else is increasing. How are you all able to do this?

The good folks over at Policy and Medicine have put together a handy chart of companies that disclose their educational grant payments for 2009 and 2010.

I know Boston restaurants have been clamoring to repeal the two-year-old Massachusetts Pharmaceutical and Medical Device Manufacturer Code of Conduct law, saying it’s hurt their business hugely to lose the doctor dinners. The code restricts informational presentations accompanied by a meal that are sponsored by medical device or drug companies to medical offices, hospitals, or device training facilities—no restaurants allowed (others blame the falloff in restaurant business to the economy, not the law). Economic development folks also wanted it gone, saying it’s been scaring off pharma and bio business: the code also bans companies from providing entertainment or recreational items of any value to HCPs, and giveaways, including pens, coffee mugs, and gift cards, along with fairly strict reporting and disclosure rules around any financial interaction between docs and drug companies.

It sounds like the Mass. House heard them all the way up on Beacon Hill: Yesterday it voted 145-4 to pass an economic development law that included chucking the gift ban. Now it has to be reconciled with an already-passed Senate bill, but I’m guessing that, the economy will trump the perceived need to rein in pharma marketing. My prediction: Given the current economic climate in the Bay state, the pharma gift ban won’t survive whatever final form the law takes.

This just in from the ACCME (press release):

Chicago, June 28, 2010— The Accreditation Council for Continuing Medical Education has provided additional guidance related to the role of ACCME-defined commercial interest employees in accredited CME. The guidance outlines the ACCME standards for ensuring independence for CME about discovery and research.

We are providing the updated guidance as a result of discussions we have had over the last several months with accredited providers concerning the role of commercial interest employees in accredited CME about research and discovery. The ACCME’s objective is to support the free flow of scientific exchange while safeguarding accredited CME from commercial influence.

The 2004 ACCME Standards for Commercial Support: Standards to Ensure Independence in CME Activities call for accredited providers to produce accredited CME that is independent and free of the control of ACCME-defined commercial interests.

In 2009, in response to questions from providers, the ACCME provided guidance about the role of employees of ACCME-defined commercial interests in accredited CME. The ACCME said that under some circumstances, employees of ACCME-defined commercial interests can plan, speak and present in accredited CME – and in some circumstances they cannot. This ACCME policy relates to Standard 1: Independence.

In order to serve the best interests of the public, the ACCME is careful to avoid making policy that would interfere with the translation of discovery into appropriate use.

We recognize that it is important for accredited CME to include reporting about the discovery phase of product development. We also realize that employees of ACCME-defined commercial interests are often involved in research and discovery. We appreciate that accredited providers face complex challenges when determining how to integrate discovery and research into accredited CME while safeguarding independence and complying with ACCME requirements. Over the last two years, the ACCME has worked closely with accredited providers as they have adapted their CME programs to comply with ACCME policy regarding the role of employees of ACCME-defined commercial interests in accredited CME. The ACCME and accredited providers have worked together to develop strategies that facilitate the appropriate flow of new information, while at the same time preserving accredited CME’s independence.

Together, the ACCME and accredited providers have recognized that there are circumstances where an employee of an ACCME-defined commercial interest can make a scientific presentation within accredited CME about their company’s research — and be compliant with the ACCME Standards for Commercial Support. The guidance includes examples of important factors for providers and the ACCME to consider in determining an appropriate role for an employee of an ACCME-defined commercial interest in planning or presenting accredited CME.

The ACCME will continue to answer providers’ questions and support them through the process of developing and implementing strategies to meet ACCME standards for independence.