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February 2006


Drug Company Dinners: Spam or Real Meat?
By Richard P. Mills, MD, MPH

Over the years, I’ve enjoyed getting out on occasion to drug company–sponsored dinners to interact with my local colleagues and to hear an out-of-town expert.
I must say I’m glad that the lavishness of the dinners has disappeared since the PhRMA voluntary guidelines became effective in mid-2002. However, I’ve noticed that the speaker always has expertise in an area of ophthalmology in which the sponsor has a drug to sell, like glaucoma or external disease. Neuro- and pediatric ophthalmology experts are seldom, if ever, invited to speak at these events. And I haven’t been surprised that the speakers never seem to have a bad word to say about the sponsor’s product. After all, if they did, they would find themselves crossed off the company’s speakers bureau. So, I’ve always known there was blatant bias in these drug company dinners. But at least I felt that the speaker would say a few things that weren’t partisan, and I’d go away having learned something.

But there is a new wrinkle. The FDA is beginning to hold drug companies responsible for what their speakers say. That is, at company-sponsored events where its products are discussed. The company could find itself liable for FDA penalties if a loose-lipped speaker should volunteer an off-label indication for the company’s drug or fail to discuss an important side effect that’s part of the labeling requirement. Naturally, that has captured the interest of the corporate attorneys, which is when common sense gets thrown to the wind.

The attorneys are decreeing that speakers must receive compliance training so they don’t say anything the company doesn’t want them to say. In fact, while they are at it, they decree that speakers must say what the company does want them to say! Just this week, I went through such training for a company that will remain nameless (because all the companies do it in one form or another). Online, I was made to complete the training in exactly the order prescribed, and for exactly the time allotted for it (no working ahead). That meant listening to an introduction in which the value of my time (which they were wasting) was extolled and passing a brief multiple choice test at the end to prove I’d stayed awake. But I paid attention when the narrator said, “[Speaker’s presentation] must faithfully utilize [Company’s] slide kits . . . which are designed to meet these requirements.”

I honestly wonder why the company is paying $1,000 to $2,000 honoraria for a speaker who promises to say only what the marketing division of the company wants said. An actor wouldn’t charge that much and would be more convincing. I know few ophthalmologists who would want to come to a lecture given by me if they knew my expert opinions weren’t being voiced, so I have refused for several years to give product talks. There is a better solution. The company sales reps are already on the payroll and are well-trained and coached. Why don’t they talk about product, and leave the guest speaker to talk about related, nonproduct topics? 

Until then, and since disclosures are all the rage these days, maybe we ought to require a new one: “The slides, intellectual content and opinions voiced in this presentation are not those of the speaker, but are solely those of the sponsor.” Then the audience wouldn’t feel intellectually insulted, just spammed.