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Black bag bagmen

I grew up in the 1950’s when times were simpler, and customer service was more personal.

Sealtest delivered milk and dairy products to our back door. The dry cleaner came and picked up clothes that needed special attention. Southern Foods delivered meat right to our freezer when we could afford it, and the local automobile dealer would even bring my Dad used cars to test drive every few years. And then there was the family physician.

Back then if you were sick, your doctor would make house calls. It was just like in “Gunsmoke” where Doc Adams would pay a visit to an ailing resident of Dodge City. And just like the doctors of the old west, our family medicine man showed up at our house carrying a little black bag. It contained all sorts of miraculous items, including pills which almost always cured what ailed us. We trusted our doctor to give us the right medicine because it was the right thing to do, and not because he had been paid to prescribe it. That was then and this is now.

Over the intervening years, most doctors have stopped making house calls, and their black bags have become stuffed with cash instead of cures. Last week the Greensboro News & Record published a report on doctors who accept money from pharmaceutical companies, and I was astonished to learn about the amount of green that was changing hands.

According to the report, Dr. Scott MacDiarmid, a urologist with Alliance Urology Specialists was paid nearly $609,000 between 2009 and 2012. His fees came from Allergan, Johnson & Johnson, and Pfizer. During that same period, Dr. Stephen Smith and Dr. Richard Aronson, both with Guilford Medical Associates, made $383,000 and $263,000 respectively from Eli Lilly, Merck, Forest, and Glaxo Smith Kline. There were plenty of other doctors receiving six figures for consulting, giving speeches, and, by implication, endorsing a particular brand of drug. Those included physicians from Eagle Family Medicine, Cone Health Cancer Center, and LeBauer Healthcare, among others.

I spoke with a local physician who told me that big pharma has always cozied up to large medical practices. In the beginning, he said doctors were paid to show up in Hawaii or some other exotic locale and do nothing to earn their kickback except kick back and get a tan. That raised some eyebrows and red flags, so, as time went on, those vacationing Docs were expected to deliver a speech in exchange for payment. Others were compensated for having conducted clinical trials ostensibly designed to bolster credibility of the industry sponsor’s product. Charles Ornstein, a reporter with Pro Publica, explained the problem, saying, “Patients trust their doctors to prescribe the right drugs for them and not be influenced by financial interests.” The bad news is that pay perks continue today. The good news is that they are not as pervasive as they once were.

According to Pro Publica, payments to physicians from pharmaceutical companies declined between 2011 and 2012, primarily due to increased transparency, and to drugs losing patent protection. The former is a result of the Physician Payment Sunshine Act, which now gives patients and the media unprecedented access to data regarding cash deals between doctors and the drug industry. Glaxo Smith Kline, for example, announced back in December that they would no longer pay doctors to make promotional speeches. However, GSK still compensates physicians to conduct clinical trials, a practice which has increased nationwide among many big companies. In fact, according to Pro Publica, over 1,300 researchers now have personal or promotional ties to drug companies.

Fortunately, most academic medical centers have adopted strict rules that govern the way clinical trials are conducted, and the kinds of speeches their doctors can deliver when being paid by a pharmaceutical company. Dr. John McConnell, CEO of Wake Forest Baptist Medical Center shared with me his hospital’s conflict of interest policy which establishes specific guidelines. For example, Wake’s policy precludes its doctors from being involved in “any marketing program designed by an industry solely to influence purchasing or prescribing decisions.” Also, compensation or honoraria accepted by a doctor for delivering a speech “must be reasonable and reflect fair market rates.” Moreover, Wake physicians who deliver outside speeches can’t even use power point or slides provided by an industry sponsor. In addition, WFBMC has its own Conflict of Interest office that monitors and reports on industry funded presentations. And while such oversight by teaching hospitals is admirable, it is discouraging to know that so many area physicians in private practice are still accepting large sums of money from big pharma.

Old Doc Adams carried a black bag alright, but he wasn’t a bagman for drug companies. Truth is he never took a dime from anyone except for his patients, and often times not even from them. That’s because a good doctor thinks more of healing than he does of being well healed. !

JIM LONGWORTH is the host of “Triad Today,” airing on Saturdays at 7:30 a.m. on ABC45 (cable channel 7) and Sundays at 11am on WMYV (cable channel 15).

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