On Tuesday, December 17th, 2013, GlaxoSmithKline, the sixth-largest global drug maker, announced that it would soon discontinue the practice of paying doctors to speak about its drugs and the diseases treated by its medicines. Promotional speaker programs have been widely used in the industry and many companies consider them a necessary component of any marketing strategy. While this GSK policy may seem like a radical change, the end of speaker programs began years ago. According to ProPublica, which lists industry payments to physicians on its website, GSK spending on promotional speaking dropped from $13.2 million per quarter in 2010 to $2.5 per quarter in 2012. Whether other companies will follow GSK’s lead is unclear, but these trends in the reduction of speaker programs and size of speaker bureaus can be seen in almost every other pharmaceutical company.
The demise of speaker programs is multifactorial. Public concerns about conflicts of interest as well as government settlements (such as GSK’s $3 billion one) likely play a major role. However, other factors include the increased role of insurance companies in prescribing decisions and the Sunshine Act, which requires companies to report not only payments to physician speakers, but also to physician attendees who may be concerned that their attendance at these programs could be perceived as a “kickback.” However, the declining role of speaker programs actually began with industry-imposed restrictions on venues and guests. This was eventually followed by a regulatory environment that has led speakers to essentially present the package insert, since they are restricted from saying anything else.
As an academic physician who has served on many speaker bureaus over the years, I mourn the loss of the speaker program. Understanding therapeutics is complex, and choosing the best agent for your patient can be quite challenging. Even if clinicians had time to review the data (which they rarely do) or were willing to spend time with company representatives (again, rare), often the best way to learn about therapeutics and evidence-based practice is from a clinical colleague with disease state expertise and product familiarity. Despite the restrictions currently placed on most promotional programs, as a speaker I have always found that my peers learn something useful during question and answer sessions.
While I recognize the inherent conflicts of interest of promotional programs and concerns about “irrational” prescribing that some stakeholders may have, I believe that an unintended consequence of the loss of speaker programs will be that doctors are less informed about potentially beneficial therapeutic products for their patients.
Given the likely future loss of this often valuable peer interaction, the pharmaceutical industry will need to think creatively about venues at which practitioners can interact with knowledgeable peers—not just pharma sales reps. This could mean something as simple as expanding the pool of medical science liaisons and/or increasing the percentage of MDs among their ranks, as these professionals have fewer restrictions than sales reps on what they can discuss.
Or, it could mean more radical changes. What if the pharma industry employed physicians to practice in free clinics for low-income families and used these company docs to speak? Regardless, the speaker program is currently on life support and the prognosis is poor. That means the industry should start experimenting with ways to replace peer-to-peer interactions as soon as possible.