Good morning friends. This is a super short note to alert you that senior author Andrew Foy has posted his opinions on our recent JAMA paper. You may not be following Andrew so I wanted to link to his Substack. Stop and Think is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
One of my colleagues is a major speaker for all of the anticoagulant drugs. While the amount of money he makes as a speaker they seem high. It is less than the amount of money he would make if he simply stayed in town and worked as a cardiologist. The majority of the funds are paid for travel outside of his home often a plane trip and not usually to a resort destination. It's usually a smaller town where a small number of very grateful physicians get to interact with a very smart colleague. As his friend and as the leader of our group, I've had many conversations regarding this with him. To his credit, he is extremely open and tells all of his patients that he is a speaker for the drug he's prescribing and received substantial compensation. I've even had conversations about this with a head attorney for the office of inspector general in the United States when I was invited to speak at the bar association meeting . The OIG attorney immediately said a person traveling outside of town to get a couple thousand dollars is not even on their radar and has no concern to him. He then proceeded to tell me the cases of fraud that they are dealing with and it is something out of the movies. Getting back to my colleague, he enjoys teaching these physicians in the small town; while yes he follows the slide deck, it's an opportunity for the docs to talk about general cardiology with someone who's quite knowledgeable. it provides him with job satisfaction outside his role of seeing patients. On paper though it looks bad. I realize he is the minority in terms of his openness.I say this because industry participation has helped patient care facilitating his interaction with the doctors. The other unique part is that he has been a speaker for all of the medication's of a class. It turns out that anticoagulation in general is not prescribed ideally putting many people at risk of stroke and or bleed. I think in his case there is a net benefit and for that reason, I continue to support those activities. He's clearly the minority though.
If we're being forthcoming. I believe that the American College of cardiology should require speakers as part of their disclosure, especially when they're talking about new technology, to list actual W-2 income, not simply that they are supported. If you're about to tell me about a new valve and you've been paid $3 million as personal income that's a different story than money to do the research.
John -- Thanks for the link to Andrew Foy's substack. It is most enlightening and strong indictment of many of our medical colleagues corrupt relationship with industry.
Thank you. This deserves wide distribution. An important quote from the publication:
“Finally, waning clinical skills and lack of confidence in clinical judgment promote a bias toward intervention, especially the overutilization of diagnostic testing. “
One of my colleagues is a major speaker for all of the anticoagulant drugs. While the amount of money he makes as a speaker they seem high. It is less than the amount of money he would make if he simply stayed in town and worked as a cardiologist. The majority of the funds are paid for travel outside of his home often a plane trip and not usually to a resort destination. It's usually a smaller town where a small number of very grateful physicians get to interact with a very smart colleague. As his friend and as the leader of our group, I've had many conversations regarding this with him. To his credit, he is extremely open and tells all of his patients that he is a speaker for the drug he's prescribing and received substantial compensation. I've even had conversations about this with a head attorney for the office of inspector general in the United States when I was invited to speak at the bar association meeting . The OIG attorney immediately said a person traveling outside of town to get a couple thousand dollars is not even on their radar and has no concern to him. He then proceeded to tell me the cases of fraud that they are dealing with and it is something out of the movies. Getting back to my colleague, he enjoys teaching these physicians in the small town; while yes he follows the slide deck, it's an opportunity for the docs to talk about general cardiology with someone who's quite knowledgeable. it provides him with job satisfaction outside his role of seeing patients. On paper though it looks bad. I realize he is the minority in terms of his openness.I say this because industry participation has helped patient care facilitating his interaction with the doctors. The other unique part is that he has been a speaker for all of the medication's of a class. It turns out that anticoagulation in general is not prescribed ideally putting many people at risk of stroke and or bleed. I think in his case there is a net benefit and for that reason, I continue to support those activities. He's clearly the minority though.
If we're being forthcoming. I believe that the American College of cardiology should require speakers as part of their disclosure, especially when they're talking about new technology, to list actual W-2 income, not simply that they are supported. If you're about to tell me about a new valve and you've been paid $3 million as personal income that's a different story than money to do the research.
John -- Thanks for the link to Andrew Foy's substack. It is most enlightening and strong indictment of many of our medical colleagues corrupt relationship with industry.
Thank you. This deserves wide distribution. An important quote from the publication:
“Finally, waning clinical skills and lack of confidence in clinical judgment promote a bias toward intervention, especially the overutilization of diagnostic testing. “