On the Hooked: Ethics, Medicine and Pharma Blog, Dr Howard Brody wonders about the reason Wyeth paid Dr Carlat so generously. Was it really because he was so good at persuading other doctors to prescribe Effexor? Or was it "to pay him $30K in bribes to get him to prescribe more Effexor in his own practice?"
On the Carlat Psychiatry Blog, Dr Carlat himself went over some of the comments he has been getting since he published his article. Some were hostile, calling him a "hypocrite," etc. There were equally hostile comments on some of the other blog posts on this topic. This is not very surprising. Dr Carlat's article raised ethical questions about marketing practices frequently used by pharmaceutical companies (and probably also biotechnology companies and device manufacturers). A lot of people make a lot of money from these practices, not only the well-paid physician speakers, but the drug reps who recruit them, and the marketing executives who are responsible for the whole mess. I bet they are not all happy with their exposure in the NY Times Magazine. Recall a quote I posted from the Aspen Health Forum, " there are powerful economic forces invested in this current culture. It would be foolish and naive to think they won't resist change."
Some of Dr Carlat's commentators thought he should return the $30K he got as a "lunch and learn" speaker. Maybe so. But Dr Carlat has clearly done a lot to atone for his previous mistakes. Not only did he write "Dr Drug Rep," but he now produces the Carlat Psychiatry Report, which is independent of pharmaceutical funding, and he periodically skewers unethical practices on the Carlat Psychiatry Blog. Thus, he is devoting a lot of effort to becoming the antithesis of a "drug lunch" speaker. More power to him, I say.
More power to him, especially since this post on the PostScript blog (by the Prescription Project) noted that Carlat's article yesterday was the most frequently emailed NY Times article. (Right now it is the #3 emailed and the #7 blogged article.) The post hopefully concludes,
Does all this add up to our nation taking stock, just as Carlat did, about the ethics and consequences of our relationship with medicine and the pharmaceutical industry, and the relationship we permit between the two? Perhaps. Or perhaps it’s too a big leap to see the patchwork of moves by individual, corporate, academic, and public healthcare stakeholders as the actions of a united, albeit clumsy, moral agent. Either way, it seems we can read the growing policy and media attention—measured in bills and newspaper inches and airtime—like a loudening macro version of the silent internal dialogue Carlat describes having with his conscience after each Wyeth talk he gave.
It will be interesting to follow this story and see whether this interplay among policymakers, press and the public concludes, as Carlat’s tale did, in a collective, incremental 'No Thanks.'
Again, I can at least dream that that this marks the beginning of the end of the "anechoic effect." Again, bravo, Dr Carlat.