Thursday, April 10, 2008

Big Pharma and the Society of Hospital Medicine meetings

The Society of Hospital Medicine regional and national meetings have grown rapidly in popularity due to the wide variety and high quality of their educational offerings. Although the success of these meetings is due in no small part to support from pharmaceutical companies, such support is controversial. Critics simplistically paint all industry support with the same broad brush, but there can be different degrees of involvement. At SHM 2008 several evening satellite symposia offered CME credit for a single topic presentation sponsored by a single company whose product related to the topic. Such activities are potentially problematic in contrast to the general sessions where industry support is broad based and insulated from meeting content.

Few would dispute that sales pitches and CME presentations whose topics directly relate to sponsors’ products influence doctors in favor of the products. It is also argued, but not supported by even a shred of evidence, that such promotions are harmful to patients. Although promotions may influence doctors away form best practice it is equally plausible that they influence doctors toward best practice. A case in point is that two of the seven satellite symposia were about DVT prophylaxis, a practice shown in study after study to be widely under utilized. The same was true for evidence based heart failure treatments such as beta blockers and ACE inhibitors back when those medicines were under utilized, on-patent and heavily promoted.

The critics, of course, claim to argue from evidence. Indeed, although there is no literature about patient outcomes much of the published material appears to show that the predominant influence on doctors is away form best practice. The problem with this large body of evidence, however, is that it’s biased. This bias manifests itself in the fact that the prescribing behaviors chosen for study are almost always ones known to be over utilized, e.g. antibiotic use and prescription of expensive antihypertensives. Nowhere in this vast repository of articles will you find surveys of doctors’ use of ACE inhibitors and beta blockers for heart failure, anticoagulation for atrial fibrillation or low molecular weight heparin for DVT prophylaxis.

But I digress. What about the general sessions? I believe adequate firewalls are in place to preserve the scientific rigor of the content. Next time you attend a national meeting of your specialty I challenge you to closely examine the general sessions and cite any content you think departs from best evidence to the potential harm of patients, and share your experience with me. And, if you don’t consider it beneath you, go to the exhibit hall and tell some of the reps you appreciate their support of the meeting.

No comments: