Adopting a 'Professional Paradigm'

At the presidential symposium “The Psychiatrist's Relationship With Industry” (see Original article: Experts Call for New Ways to Collaborate With Pharma), private practitioner Jonathan Weker, M.D., of Montpelier, Vt., presented a historical overview of the evolution of prescribing from its earliest days as a mercantile exercise by physicians who were essentially marketing products to the growth of the modern pharmaceutical manufacturing corporation and the contemporary regulatory structure.

“Pharmaceutical companies began to develop therapeutic agents of demonstrable utility, safety, and efficacy, which had appeal to a large market,” he said. “And doctors became the portal through which access to those medicines took place. Where once patients came to doctors primarily seeking surgery or diets, now they wanted prescription drugs.”

With the emergence of blockbuster drugs, pharmaceutical companies became enormously attractive to investors. “They began to experience a kind of financial success they could not have imagined before,” he said.“ With this, the nature of pharmaceutical companies and their relationships with doctors irrevocably changed.”

Weker suggested two possibilities for how this new relationship might have evolved: a professional paradigm in which each party is principally concerned with improving the health of the populace or a mercantile model.

“In the mercantile paradigm, physicians act as surrogate consumers on behalf of their patients, and the companies court the doctors on behalf of their products.” This created a situation in which clinical concerns were not ignored, but they were not alone on the table. “Both parties were not disinterested,” he said. “My sense is that a de facto decision was made by both parties to adopt this mercantile paradigm.”

But within the last two or three years there has been a rapid turnabout: the public and federal and state legislators are demanding accountability and transparency. “No one wants Christmas to end, but Christmas is going to end,” he said.

He urged adoption of a new relationship with the pharmaceutical industry in which the professional integrity of physicians is respected, and doctors receive comprehensive, well-reasoned, unmarketed information about drug products.

“Their products make our practice look good, but at the same time our ability to diagnose and treat makes their products look good,” Weker said. “If industry and the individual physician wish to coexist symbiotically in this environment, both parties would be better served by adopting the professional paradigm.” ▪