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Should NPs Accept Paid Speaking Engagements from Pharmaceutical Companies?
POINT
counter-point
Susan Rawlins
Susan Rawlins, MS, RNC, WHNP, of Pottsboro, Texas, is a women’s health nurse practitioner with Greater Texoma Health Clinic and the Grayson County Health Department and the director of education for the National Association of Nurse Practitioners in Women’s Health. She earned her BS and MS in nursing from Texas Woman’s University and her preparation in women’s health care from the nurse practitioner program at University of Texas Southwestern Medical School in Dallas. She serves as national affiliate representative on the American College of Nurse Practitioners board of directors.
Donald Gardenier
Donald Gardenier, DNP, FNP-BC, is an assistant professor, clinical program director, and a primary care nurse practitioner at the Mount Sinai School of Medicine in New York City. He is a member of the board of directors of the American College of Nurse Practitioners and serves on the editorial board of the Journal for Nurse Practitioners.
Should NPs Accept Paid Speaking Engagements from Pharmaceutical Companies? Once merely secondary targets of pharmaceutical companies, nurse practitioners (NPs) are fast moving onto their primary target lists. No wonder: in 2004, NPs were reported to collectively prescribe 494 million prescriptions per year. In a 2005 salary survey, 7% of respondents reported that they supplement their income by speaking at pharmaceutical company-sponsored events. For physicians, some speaking engagements can be quite lucrative and can pull well-respected physicians away from practice. A recent Boston Globe report indicated that the highest-paid physician speaker engaged by a pharmaceutical company made over $99,000 within a 90-day period in 2009. Some teaching hospitals now forbid their provider staff to participate in any pharmaceutical company-sponsored educational event. Is it ethical for NPs to be paid by companies to use their skills, knowledge, and, more importantly, their unique perspective, to educate peers, consumers, and others about new pharmaceutical products? Is this an important service that deserves fair compensation, or is it impossible to prevent the bias that some consider inherent with any compensated speaking engagement? What do you think? Contact Section Editor Janet Selway at [email protected] if you would like to comment on this matter.
Online Poll: What is your view on this topic? Go to www.npjournal.org to vote. 532
The Journal for Nurse Practitioners - JNP
Volume 6, Issue 7, July/August 2010
Support for
Rationale Against
NPs Speaking for Pharma
NPs Speaking for Pharma
Susan Rawlins
Donald Gardenier
es, NPs should be involved in disseminating accurate information about new pharmaceutical products and medical devices to peers, and they deserve appropriate compensation. NPs have a professional obligation to learn about new pharmaceutical products, devices, and clinical procedures and incorporate them into practice in a timely manner. NPs obtain this knowledge through continuing education (CE) programs, journal articles, non-CE productspecific programs, and interactions with pharmaceutical sales representatives and with each other. CE programs are balanced presentations about conditions or classes of drugs that treat a condition and should be the major source of information on which providers base clinical decisions. While pharmaceutical sales representatives are knowledgeable people, they are usually not clinicians and can only repeat what they have been taught when presenting information about a new drug. Pharmaceutical companies typically invite speakers who are clinicians with personal experience prescribing the new product or who were involved in research for approval of the new product. The speaker is ethically obligated to disclose all financial relationships that involve the sponsoring company and legally obligated to present only uses of a product that have been approved by the Food and Drug Administration (FDA). Before presentation, the information will be reviewed by the company’s legal department to make sure it is accurate and in compliance with FDA labeling. An NP who has already incorporated the product into practice not only can explain drug pharmacokinetics and pharmacodynamics but also provide concrete examples of patients who particularly benefited from the new product or had adverse reactions. An NP speaker could identify barriers to incorporating the new product into practice and present strategies to overcome those barriers. Because the pharmaceutical company has asked the NP to perform a professional activity, the NP should be compensated for the time spent developing and presenting the information.
y favorite studies of physicians’ attitudes about the promotion of pharmaceuticals show that the physicians believe that other physicians are influenced by marketing but they themselves are not. In another study, physicians understood the concept of conflict of interest, yet those same physicians held largely favorable views of interactions with pharmaceutical detailers. For those who would like some insight on how marketing can affect patient care, I recommend the OxyContin® story in the February 2009 issue of Health Policy and Ethics. Little research has been done specifically on NPs’ relationships with those who promote pharmaceuticals, devices, and services. My feeling is that, in this area, we differ little from our physician colleagues. These relationships are governed by shared principles of psychology. Like the physicians in the studies, NPs whose clinical judgment I respect and who claim to have an evidence-based approach to patient care have told me that marketing practices have no effect on them. Psychologists have a term that describes this status quo: cognitive dissonance. It would be bad enough if our beliefs merely defied the precepts of human behavior. A growing body of evidence and attention in the lay press tell us that the eyes of the public are upon us and they believe we are influenced by marketing much more than we think we are. This is evidence coming directly from our patients, and we should probably pay attention. When the issue is our patients’ confidence, whether a conflict of interest is real or perceived makes little difference. When we accept money from a sponsor for a speaking engagement, we become part of their marketing strategy, and we either favor or appear to favor that sponsor’s interests over those of our patients. Think of it this way: What amount of explanation would convince you that the lobbyist-sponsored golf outing had no effect on your elected official’s position on an issue?
Y
M
1555-4155/$ see front matter © 2010 American College of Nurse Practitioners doi:10.1016/j.nurpra.2010.05.016
www.npjournal.org
The Journal for Nurse Practitioners - JNP
533
counter-point
Susan Rawlins
Susan Rawlins, MS, RNC, WHNP, of Pottsboro, Texas, is a women’s health nurse practitioner with Greater Texoma Health Clinic and the Grayson County Health Department and the director of education for the National Association of Nurse Practitioners in Women’s Health. She earned her BS and MS in nursing from Texas Woman’s University and her preparation in women’s health care from the nurse practitioner program at University of Texas Southwestern Medical School in Dallas. She serves as national affiliate representative on the American College of Nurse Practitioners board of directors.
Donald Gardenier
Donald Gardenier, DNP, FNP-BC, is an assistant professor, clinical program director, and a primary care nurse practitioner at the Mount Sinai School of Medicine in New York City. He is a member of the board of directors of the American College of Nurse Practitioners and serves on the editorial board of the Journal for Nurse Practitioners.
Should NPs Accept Paid Speaking Engagements from Pharmaceutical Companies? Once merely secondary targets of pharmaceutical companies, nurse practitioners (NPs) are fast moving onto their primary target lists. No wonder: in 2004, NPs were reported to collectively prescribe 494 million prescriptions per year. In a 2005 salary survey, 7% of respondents reported that they supplement their income by speaking at pharmaceutical company-sponsored events. For physicians, some speaking engagements can be quite lucrative and can pull well-respected physicians away from practice. A recent Boston Globe report indicated that the highest-paid physician speaker engaged by a pharmaceutical company made over $99,000 within a 90-day period in 2009. Some teaching hospitals now forbid their provider staff to participate in any pharmaceutical company-sponsored educational event. Is it ethical for NPs to be paid by companies to use their skills, knowledge, and, more importantly, their unique perspective, to educate peers, consumers, and others about new pharmaceutical products? Is this an important service that deserves fair compensation, or is it impossible to prevent the bias that some consider inherent with any compensated speaking engagement? What do you think? Contact Section Editor Janet Selway at [email protected] if you would like to comment on this matter.
Online Poll: What is your view on this topic? Go to www.npjournal.org to vote. 532
The Journal for Nurse Practitioners - JNP
Volume 6, Issue 7, July/August 2010
Support for
Rationale Against
NPs Speaking for Pharma
NPs Speaking for Pharma
Susan Rawlins
Donald Gardenier
es, NPs should be involved in disseminating accurate information about new pharmaceutical products and medical devices to peers, and they deserve appropriate compensation. NPs have a professional obligation to learn about new pharmaceutical products, devices, and clinical procedures and incorporate them into practice in a timely manner. NPs obtain this knowledge through continuing education (CE) programs, journal articles, non-CE productspecific programs, and interactions with pharmaceutical sales representatives and with each other. CE programs are balanced presentations about conditions or classes of drugs that treat a condition and should be the major source of information on which providers base clinical decisions. While pharmaceutical sales representatives are knowledgeable people, they are usually not clinicians and can only repeat what they have been taught when presenting information about a new drug. Pharmaceutical companies typically invite speakers who are clinicians with personal experience prescribing the new product or who were involved in research for approval of the new product. The speaker is ethically obligated to disclose all financial relationships that involve the sponsoring company and legally obligated to present only uses of a product that have been approved by the Food and Drug Administration (FDA). Before presentation, the information will be reviewed by the company’s legal department to make sure it is accurate and in compliance with FDA labeling. An NP who has already incorporated the product into practice not only can explain drug pharmacokinetics and pharmacodynamics but also provide concrete examples of patients who particularly benefited from the new product or had adverse reactions. An NP speaker could identify barriers to incorporating the new product into practice and present strategies to overcome those barriers. Because the pharmaceutical company has asked the NP to perform a professional activity, the NP should be compensated for the time spent developing and presenting the information.
y favorite studies of physicians’ attitudes about the promotion of pharmaceuticals show that the physicians believe that other physicians are influenced by marketing but they themselves are not. In another study, physicians understood the concept of conflict of interest, yet those same physicians held largely favorable views of interactions with pharmaceutical detailers. For those who would like some insight on how marketing can affect patient care, I recommend the OxyContin® story in the February 2009 issue of Health Policy and Ethics. Little research has been done specifically on NPs’ relationships with those who promote pharmaceuticals, devices, and services. My feeling is that, in this area, we differ little from our physician colleagues. These relationships are governed by shared principles of psychology. Like the physicians in the studies, NPs whose clinical judgment I respect and who claim to have an evidence-based approach to patient care have told me that marketing practices have no effect on them. Psychologists have a term that describes this status quo: cognitive dissonance. It would be bad enough if our beliefs merely defied the precepts of human behavior. A growing body of evidence and attention in the lay press tell us that the eyes of the public are upon us and they believe we are influenced by marketing much more than we think we are. This is evidence coming directly from our patients, and we should probably pay attention. When the issue is our patients’ confidence, whether a conflict of interest is real or perceived makes little difference. When we accept money from a sponsor for a speaking engagement, we become part of their marketing strategy, and we either favor or appear to favor that sponsor’s interests over those of our patients. Think of it this way: What amount of explanation would convince you that the lobbyist-sponsored golf outing had no effect on your elected official’s position on an issue?
Y
M
1555-4155/$ see front matter © 2010 American College of Nurse Practitioners doi:10.1016/j.nurpra.2010.05.016
www.npjournal.org
The Journal for Nurse Practitioners - JNP
533