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RENT a Doctor Comes Clean

The Milwaukee Journal Sentinel Online has:

Physician Found Money, Acclaim Seductive

The 1990s was a heady time for the pharmaceutical industry, which had just embarked on what would become known as the Statin Wars. And James Stein, an up-and-coming heart doctor, was ripe to be hooked as a drug company speaker.

Stein, now a professor at the University of Wisconsin School of Medicine and Public Health, was a 29-year-old cardiology fellow in Chicago in 1994 when his faculty mentor asked him to fill in for him at a drug company-funded lecture to a large group of doctors.

It would be his first taste of life as a drug company speaker and consultant.

Stein got first-class airfare to Dallas. A limousine took him to a luxury hotel for the talk.

He walked off the stage, and a doctor from the conference handed him an envelope containing a $500 check.

"I got a pat on the back and he said, 'There's more where that came from, son.' I had no idea what that meant, but I went home and paid off part of my student loans," Stein said in a presentation at UW this month.

Stein was among dozens of UW doctors and an untold number of physicians nationwide who have pulled in large sums doing talks or working as consultants to drug and medical device companies.

Now these financial arrangements are being threatened. Top universities and the medical profession are riding out a gathering storm over the ethics of financial relationships between drug companies and doctors. More and more, restrictions are being placed on these relationships, in part over concerns they raise the cost of drugs, threaten the integrity of medicine and may even be harmful to patients.

Stein's first drug company talk led to more than a decade of work for drug companies before he gave it up for ethical reasons. Now he is speaking out.

Over the years, many of the big names in the drug industry would hire Stein to give speeches or serve as a consultant, eventually leading to fees of $2,000 to $3,000 per talk.

Stein told his cautionary story to medical students, doctors and others at a UW conference this month on conflicts of interest in medicine.

"It was a compelling personal story of someone who tried to have it both ways and realized he couldn't do it," said Norman Fost, a professor of pediatrics and director of the bioethics program at UW.

Changing their approach

Leon Rosenberg, a professor of molecular biology at Princeton University, said Stein joins a few other doctors from around the country who have spoken out publicly and turned away from industry money.

"There is a real force in that direction," said Rosenberg, the former chief science officer at Bristol Myers Squibb.

Representatives of Pfizer, a drug company for whom Stein did substantial consulting work, listened to his presentation.

"I think he has had a change of heart," said Joe Hammang, Pfizer's senior director for science policy and public affairs. "We respect the doctor's decision."

However, Hammang said many of the concerns Stein talked about occurred prior to major changes in conflict-of-interest policies at Pfizer and throughout the drug industry.

About a month after his first talk in 1994, Stein was asked by another drug company to give a lecture on cholesterol at a small hospital in Chicago, just as blockbuster statin drugs were coming on the market.

"I was really flattered because over and over again I was told that I was a future thought leader," he said. "I did my talk. I got a $750 honorarium and I was hooked."

Stein said he now realizes that the speech at the hospital was just an audition.

"They wanted to know what I would say and how I would deliver," he said. "And I think they also wanted to know what I would say about their product."

He joined speakers bureaus for several drug companies. It was a kind of badge of honor, he said. The more companies a doctor spoke for, the more highly he or she was regarded.

Stein, now 44, came to UW in 1996. Over the years, he would give talks and do other work for many of the top names in the pharmaceutical industry.

For instance, in 2005 Stein did work for six drug makers, according to a disclosure form filed with UW. That year, Pfizer paid him between $10,000 and $20,000 for four days of work as a speaker and advisory board member.

LipoScience, a firm that markets a cholesterol test, paid him $10,000 to $20,000 for four days of similar work.

Another firm, Schering-Plough, paid him about $12,000 for two days as a lecturer.

Although he said he had concerns about the propriety of his work, Stein said he was assured by his superiors there was nothing wrong with it as long as he did it on his own time. Indeed, they said it enhanced the reputation of the university.

And, he said, he considered himself an educator, not a salesman.

He said he tried to manage any conflicts of interest by disclosing who paid him, controlling the content of what he said and doing the work on personal time.

The ground shifts

Things started to change rapidly beginning several years ago.

Drug companies began referring to the talks as promotional. They wanted him to use their slides; he refused. Then, medical journals and the lay press began printing articles questioning the ethics of the relationships.

A 2006 article in a Madison newspaper listed Stein as being among the UW doctors who reported the most money from the drug industry. Stein said he was embarrassed.

But, he said, he continued to try to manage his relationships with drug companies. He sent letters to patients disclosing his ties to industry. As of December 2006, he donated all the money from his talks to charity.

Why didn't he just stop doing the work?

He said he believed he could save more lives lecturing than by working in the emergency room. Stein said he saw no harm in being paid. But he admitted that giving the talks also made him feel important.

At the same time, new scientific articles suggested that it is impossible for doctors to be unbiased when they receive gifts or payments from drug companies.

"I have learned that human beings, physicians included, are incapable of recognizing bias in themselves, and even when you try not to be biased it is impossible to avoid it, especially when money is involved," he said.

More importantly, huge fines or convictions for gross ethical conduct were being issued against every drug company that he worked with. Doctors were being investigated on allegations of taking kickbacks.

At the same time, the field of continuing medical education was being criticized for promoting the drugs of companies that paid for the courses.

Stein noted a January story in the Journal Sentinel that raised concerns about a UW continuing medical education course on hormone therapy for women that was paid for by Wyeth, a company that makes hormone products.

He said he came to realize that drug and medical device firms were no longer trustworthy partners in medical education.

He also said it has become obvious that patients have the least power and drug companies have the most power.

"I was wrong," he said.

Stein said he stands by what he taught.

But, he added, "I was naïve to think I was not influenced by the money and power of the drug and device companies."

As of last December, he said, he stopped all drug company speaking and consulting other than bona fide research.

This makes it 3 so far from U Wisconsin.

2: Quit Smoking? See "My Time To Gag" At Pharmalittle 1st

3: Getting It In The Neck: $19 Million To 1 Doctor

"Lucius Cassius ille quem populus Romanus verissimum et sapientissimum iudicem putabat identidem in causis quaerere solebat 'cui bono' fuisset."

"The famous Lucius Cassius, whom the Roman people used to regard as a very honest and wise judge, was in the habit of asking, time and again, "To whose benefit?"

Marcus Tullius Cicero

Hat Tip to University Diaries