Fighting back

Starting the second day with a clarion call to academics and industry alike, Tom Stossel, Professor of Medicine at Harvard Medical School and Senior Fellow at Manhattan Institute for Policy Research presented a strong case for the use of KOLs by the pharmaceutical industry. Far from being a cause of embarrassment, mentioned sotto voce, Stossel sees that KOL-industry relations are a cause for celebration. No apologies, no need for apologies.

Stossel contrasts two models of healthcare research that he calls Plan A and Plan B. Plan A "Innovation for Profit" is market-driven and describes a condition in which private biomedical research funding outstrips national support, a model that has held sway since 1990 in the US. At the same time, there has been an explosion articles on conflict of interest. 'In Plan A, conflict of interest is a good thing' says Stossel 'It's fair, creative competition'. Somehow this has become distorted to the stage where conflict of interest is synonymous with corruption. No smoke without fire. Plan B, over-regulation and excessive disclosure in Stossel's eyes, has arisen in response.

Stossel doesn't buy this. Disclosure has reached the point where it invites ridicule: He caricatures a world where he cannot have a slice of pizza with a drug rep without completing disclosure forms. Plan B is Intelligent Design versus the evolution of Plan A to paraphrase Stossel's terminology.

Opponents of Plan A cite bribery and kickbacks, gift-laden physician prescribing brand products, promotion exposing patients to dangerous drugs, and unnecessary health care costs. Stossel disagrees. 'Plan A is great' he says 'it's not perfect because we're human beings and we do dumb things' On the other hand Stossel sees Plan B's over-regulation as doing little more than empowering litigation lawyers and journalists.

Stossel went on to say that Plan B is insulting, hypocritical, and not evidence-based. He sees the dislike of profit as it primary motivation and couches this as a long-standing human tradition.

So what is to be done? Stossel ended his talk with a four-pronged call to arms - value creators in medical practice, expose the critics, explain the value of collaborations to others and, finally, hold the media accountable.
In the spirit of the conference Stossel's last slide cited his conflicts of interest — many drug companies and, almost proudly displayed, a 1964 arrest for brawling...