The Willamette Weekly ran a profile of Dr Erick Turner, the author of a systematic review that showed incorporating the results of unpublished trials of selective serotonin reuptake inhibitor (SSRI) anti-depressants into the review produces much less optimistic results about these drugs than simply attending to the published trials. [Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252-60. Link here.] What is notable in the Willamette Weekly article is the account of how Dr Turner was once also a "Dr Drug Rep." (see our post here, and the Carlat Psychiatry Blog, written by the original former "Dr Drug Rep," Dr Daniel Carlat, here.)
... for 18 months, Turner pimped for antidepressants. He wouldn’t put it that way, of course, as many doctors do the same thing. But starting in 2004, Turner, who is the medical director of the Mood Disorders Program at the Portland VA and has worked at the Food and Drug Administration and the National Institute of Mental Health, became a speaker for Eli Lilly, one of the world’s largest pharmaceutical companies.
It’s not unusual in pharmaceutical marketing for doctors to be hired as 'consultants'—or members of a company’s 'speakers' bureau' in industry parlance—and then hit the road doing 'doctor talks.' These are typically lunches or dinners where area M.D.s are invited by a company to eat and drink while listening to a respected physician describe the benefits of a particular drug.
Lilly approached Turner around the time the FDA was set to approve a new Lilly antidepressant named Cymbalta. He was an especially good catch for the company because, in addition to his academic appointment at OHSU, Turner had spent seven years as a researcher at the prestigious National Institute of Mental Health and another three years as a clinical trials reviewer at the FDA.
'They’re using your reputation and political capital, as it were, as sort of a frontman for the drug,' says Turner, 54.
After training in Indianapolis in the summer of 2004, Lilly sent Turner out into the field in the Northwest, receiving anywhere from $500 to $750 per talk. He says he did about 12 talks for Lilly over the next 18 months.
He says his motivation wasn’t so much the money—he netted less than $10,000—as it was his desire to keep up his reputation as an expert on clinical trials.
Dr Turner discussed the positive incentives to do drug company talks.
But Dr Turner soon realized that his talks were really not under his own control.
'In the beginning, I think I got narcissistic gratification,' he says. 'They fly you somewhere else in the country and pick you up in a limo, and you stay in a nice hotel you could never afford otherwise.'
Turner found he could say only what Lilly allowed him to say. He could use only Lilly’s overhead slides of results from clinical trials of the drug. He couldn’t offer his own expertise as a researcher and former FDA reviewer to his fellow doctors.
'I began to feel straitjacketed,' he says.
Those feelings inspired Dr Turner to rebel, and to gather the data that lead to his NEJM article.
These new antidepressants—which critics argued had turned America into a culture of the quick fix and that proponents praised as lifesavers—didn’t perform very well. Turner knew this. And he decided in 2004, at the very same time he was taking money from Lilly, that it was time to start telling the truth.
'I guess you could say I bit the hand that fed,' says Turner of his revelation.
Turner quit doing doctor talks for the pharmaceutical industry in 2005, convinced he needed to make his case more strongly by collecting reports of pre-approval clinical trials for antidepressants that had not been published.
Note that Dr Turner's account of his career as a pharmaceutical company paid lecturer parallels the account of Dr Daniel Carlat in his "Dr Drug Rep" article, even though the two worked for two different companies.
Both were seduced by their treatment as minor VIPs; initially thought they were selected because of their expertise; and eventually discovered that they were only supposed to deliver the content that the drug company marketers dictated, and specifically could only show the slides that the companies' marketers had prepared for their speakers.
These are only two case reports, they both strongly suggest that physicians who give "drug talks" may be helping companies market their products, rather than imparting their professional wisdom or scientific expertise. Such talks are sales talks, not medical education. Those physicians who give them, and those physicians who attend them, should not pretend otherwise.
Hat tip to Ed Silverman on the PharmaLot blog.