Tuesday, May 23, 2006

Medical webcast: physician-Pharma relationships

My latest find is Internal Medicine Grand Rounds (traditional Grand Rounds that is) at the University of Nebraska.


Dr. Martin Tobin spoke on April 14. We know Dr. Tobin as a leader in pulmonary and critical care medicine and the originator of the “Tobin index” for liberation from mechanical ventilators (frequency to tidal volume ratio) but on this occasion he spoke on “Patients, Pharma, Physicians.” This defense of the No Free Lunch position is eloquent but listen closely for the specious arguments and generalizations. (E.g., promotion influences prescribing; is this always bad? Industry-profession relationships deserve rigorous scrutiny, but should all industry supported publications and CME be rejected out of hand? Though individuals may be unduly influenced is it fair to characterize doctors as puppets?).

An interesting tidbit from Tobin’s presentation was the extent of Eli Lilly’s involvement in the Surviving Sepsis Campaign guidelines and the closely related IHI sepsis bundle. The commercial interest in these lofty initiatives deserves exposure (here’s the inside story on ties between Surviving Sepsis and a Lilly supported public relations campaign). Some take the cynical position that these guidelines are hopelessly tainted by industry influence. I take the moderate position of skepticism which looks to the primary sources of evidence while acknowledging value in the documents.

Despite flaws in the arguments there’s enough good material in the webcast to make for worthwhile viewing. Tobin presents foundational issues with a clarity that will help sharpen one’s perspective on the ethics of physician-Pharma relationships no matter which side of the debate one adheres to.

Background: Additional medical webcasts have been cited by me as well as Clinical Cases and Images. You can find more by entering your favorite medical subject into a Yahoo search under the video tab. Over time more and more institutions are posting video archives of their grand rounds.

1 comment:

Danny Haszard said...

Well said,i applaud your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard www.zyprexa-victims.com