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Letter to the editor

USF doc's ties to pharma: Bad karma?

Saying he's objective, a professor defies a trend to ban faculty interaction with drug firms.

By Kris Hundley, Times Staff Writer
Published January 27, 2008

Dr. H. James Brownlee Jr. of the USF College of Medicine does about 30 events a year, but only for products he thinks are the best in their class. "I've turned down loads of companies," he says.
	[Daniel Wallace | Times]

TAMPA - Dr. H. James Brownlee Jr. earns about $170,000 a year as a faculty member and department head at the University of South Florida's College of Medicine.

But the veteran teacher and family practice doctor pulls in another $40,000 a year, along with free dinners and travel expenses, as a speaker for several drug companies.

It is the kind of outside faculty activity that has been banned at several medical schools recently as they seek to avoid conflicts of interest with the pharmaceutical industry.

David Rothman, a professor at Columbia University who has led the movement to distance medical schools from pharma, as the drug industry is called, compared serving on speakers bureaus to commercial sex work.

"You're their boy," he said. "If you work for the drug companies, you're not working for the school."

But Brownlee, who has been moonlighting for drugmakers since the early 1990s, said his lucrative sideline neither interferes with his university duties nor compromises his professional ethics. Whether he's promoting Crestor at dinner meetings in Tampa or talking up Januvia during a daylong meeting in Atlanta, Brownlee said he's simply pushing for better preventive care.

"I don't care if doctors use a certain product; I'm just passionate about being more proactive in treating certain disease states," he said, citing diabetes and cardiac care as two of his chief interests. "But I probably wouldn't offer to do it if I weren't getting paid."

Dr. Anthony Scialli, an obstetrician/gynecologist, spoke on behalf of drug companies while heading the residency program at Georgetown University's medical school. He said his subconscious desire to please the drugmaker shaped his presentation.

"On that rare occasion when a representative of the sponsoring company was not permitted to attend my talk, my talk was subtly different," said Scialli, who is no longer a spokesman. "I was always promoting the product, whether I believed it or not."

Brownlee, 57, is a throwback to an age when no one questioned the close ties between doctors and drug companies. But in recent years, a growing number of studies have questioned whether patients are well-served when their health care providers are being wined and dined by drugmakers.

Though doctors consistently believe they are not influenced by such promotions, industry tracking of prescribing habits proves otherwise. One study showed that a three-minute sales pitch from a drug rep resulted in a 52 percent increase in prescriptions for a new drug.

That's the key reason the drug industry spends $25-billion a year in direct marketing to physicians, with nearly 100,000 salespeople canvassing medical schools, hospitals and private practices. About a dozen states require drug companies to report how much they spend per doctor and pending federal legislation would make such reporting mandatory nationwide.

In the past two years, several medical schools, including Stanford and Yale, have forbid faculty members from taking gifts, meals and honorariums from drug companies. USF in Tampa, meanwhile, is discussing possible changes in its policies.

USF medical school professors are expected to disclose all outside activities, which are then reviewed by Dr. John Curran, associate dean of academic affairs. Curran said that less than 25 percent of the faculty is on drug companies' speakers bureaus, with Brownlee the most active. And though Curran would prefer that Brownlee limit his teaching to USF, he usually approves the engagements. He said a decision to prohibit such freelance work would have to be reached by faculty consensus, not administrative fiat.

"I am very much against these relationships with drug companies," said Curran, a pediatrician who has been with USF's medical school since it was formed 35 years ago, "though I participated in such activities in the past before I realized their significant influences on the medical profession and its educators."

Brownlee said drug companies have cut back dramatically on perks to physicians over the past few years. Drugmakers used to treat doctors to box seats at Buccaneers games and first-class airplane tickets to meetings at high-end resorts. Since 2002, however, the industry has banned freebies unrelated to the medical profession. All pharma-paid flights for speaking engagements are now economy class, Brownlee said. And free dinners at upscale restaurants like Roy's or Ruth's Chris Steak House in Tampa offer limited selections, not open menus.

"I spoke in Sarasota on headaches recently, and when one doctor wanted to order a $100 bottle of wine, the district drug rep said, 'Absolutely not,' " he said.

Brownlee said he gets $750 for a dinner speech and about $1,500 for an out-of-town engagement. He does about 30 events a year, but only for products he thinks are the best in their class.

"I've turned down loads of companies," Brownlee said, citing Vioxx and Vytorin as two drugs he refused to promote. Brownlee said he also "agreed to disagree" with the maker of Avandia, a diabetes drug, when criticized for talking too much about the disease and not enough about the product.

And Brownlee said he held his ground when an AstraZeneca rep scolded him for using some of his own slides, rather than the company's, during a talk about the cholesterol drug Crestor.

Brownlee said he understands that drugmakers want to vet everything he says for their own legal protection. But he dislikes sticking to a company-produced script, saying his credibility with peers is at stake.

"I'll get a better turnout if the audience knows I'm as balanced as possible," he said.

This reporter's request to attend one of Brownlee's speaking engagements at a Tampa restaurant was denied by the drug company. The sponsor, Merck, said that only health care providers are allowed to attend its dinners and its sales reps are not allowed to speak to the press.

Rothman, the Columbia professor, wonders what Brownlee's medical students think of his extracurricular activities.

"Why isn't he setting a better example?" he asked. "USF is really behind the curve on this issue."

Kris Hundley can be reached at hundley@sptimes.com or (727) 892-2996.

The most restrictions

U.S. medical schools with the most comprehensive policies restricting faculty interaction with drug companies.*

Stanford University

University of California, Davis

University of Pennsylvania

University of Michigan

Yale University

*As judged by the American Medical Student Association

University of Pennsylvania Health System bans physicians from accepting honorariums for talks, free meals, drug samples (patients get free generics or vouchers for medications if unable to pay), sales visits from pharmaceutical salespeople.

Stanford University Medical School prohibits physicians from accepting industry gifts, including drug samples, anywhere on the campus or at off-site clinical facilities. This includes meals for faculty members or trainees on or off campus. It also bans drug salespeople from patient care areas and medical school facilities except by appointment. Faculty are prohibited from publishing articles in medical journals that have been ghostwritten by industry representatives, and speaking on behalf of drug companies is discouraged.

[Last modified January 25, 2008, 21:51:18]