AFTER THIS FALL'S firestorm over the initial conflicts-of-interest document released with the ACCME's new Standards for Commercial Support, I have a deep appreciation for both the difficulties and the benefits of using faculty with ties to pharma. But what about those other conflicts of interest that don't often get talked about?

For example, I was speaking with a scientific affairs manager at a large pharma company who went into a bit of a rant about physicians who basically try to extort educational grants from industry. “They tell us, ‘I write 60 percent of your product, and I expect $5,000, just like we got last year.’ When I tell them we can't give them that amount, they say, ‘Well, now you'll see a change in my prescribing habits.’ It's beyond bizarre, but that's what we deal with on a daily basis.” In addition, he says that local medical societies react to a grant reduction by asking doctors on their board in that particular therapeutic area to call their pharma representative and put some pressure on.

“Talk about conflict of interest — that's a huge conflict of interest. Everybody's afraid of it. You have OIG to reduce inducements to doctors, but what about doctors inducing industry? When can industry institutions take a role against corrupt physicians who are wantonly ripping off the system by threatening us with prescription volume?” asks the scientific affairs manager. For companies who still have sales reps involved in the CME granting process, this is particularly tough because the reps often are intimidated by the physicians who, after all, are also their customers. This guy's advice is, “If the physician has the morals of a squid, you can't work with them.”

While providers have complained about losing the personal touch of having their sales reps involved, one upside of the industry's move toward centralized CME committees and online grant proposal processes is that it does take the decision-making process away from the sales reps, so reps can just avoid this type of tactic by saying it's out of their hands.

Still, why is it taboo to talk about physicians who abuse their power by browbeating CME providers into doing what they want, or threatening pharma to pull their scripts if they don't get the cash they want for their programs? If prescriptions equal power, no doc is free of having industry ties that bind — though I have to believe the number who do abuse that power is infinitesimal.

Is corruption, whoever is involved and on whatever scale, the collateral damage we have to pay to provide the education docs need to better care for patients? Call me naive, but I refuse to believe it.

Sue Pelletier, (978) 448-0377, spelletier@primediabusiness.com