Faust in His Study: Rembrandt von Rijn (1606-1690) Implanon’s manufacturer has asked me to serve as a trainer, a doctor who teaches other doctors how to insert and remove the implant. They are offering to put me up at a hotel and pay me to attend a 1 1/2 day training session being held at a nearby city.
Why me? Well, I am a family planning advocate and sometime clinical researcher who writes chapters and review articles on contraception, sits on the medical advisory board of a local family planning organization and am the “go-to” person in my department for all things contraceptive. Plus I was an insertion and removal trainer for Norplant. So, I’m a natural for the job. (Not to mention the fact that I really do believe this method is a good thing.)
The fee being offered is certainly a reasonable one for my time as a physician – any less would be an insult, any more might look coercive, and the company is really handling this thing responsibly and reliably. The hotel is in a small northeast city that no one would ever visit unless their mother lived there. There is also a training in Orlando – a fact that I consider a disincentive if anything. (I listed it on the training registration form as my third and last choice of venue.)
And yet I am conflicted. Why? Well, the backlash against big pharma has gotten so huge, and I admit that I have gotten so caught up in the groundswell that any pretense of taking money from a pharmaceutical manufacturer feels a bit like selling my soul to the devil. Having recently said goodbye to drug samples, pharma reps and their lunches, the last thing I want to do now is to serve as a paid consultant to said Big Pharma.
Yet I really do want to learn about this method, and offer it to my patients, and I like the idea of training other physicians and residents about birth control. Also, the FDA requires that insertion training be done – the problems that ultimately led to Norlant’s downfall were the result of untrained clincians inserting the method improperly or botching the removals. Someday I will post about my and my patient’s experiences with Norplant –it is a tragedy and a travesty what the media and legal institution did to this method. Suffice it to say that, as a result of that experience, I believe I have an ethical obligation as an experienced Norplant provider to train my fellow physicians in this new method called Implanon. Because if we can keep the method safe, the docs informed and the lawyers away, we may just have a future with more contraceptive options for American women.
So here’s my dilemma – should I –
A. Go to the training and keep the money?
B. Stay home and learn it from someone else?
C. Turn down the money but still do the training?
D. Force myself to do the training in Orlando as penance for taking the money?
E. Do the training but ask the drug company to send the check to Planned Parenthood?
Any and all thoughts on this matter will be greatly appreciated. I need to make a decision by the end of next week, or I could end up in Orlando.
Ubi desinit Philosophus ibi incipit Medicus
(Where the phiosopher leaves off, there the physician begins)
Be a physician, Faustus, heap up gold,
And be eternis’d for some wondrous cure. (Christopher Marlowe. Dr Faustus)
Category: Second Opinions
A, B, or E?
C is out because you should either use the money you earn, or give it to a charity (or whatever) you choose; letting the company keep it isn’t as effective as the other options.
D is out because, if you’re going to do the course, don’t make yourself miserable by going to Orlando if you don’t want to.
A vs B: As you’ve said, this is going to be a really good BC choice for a lot of women, so being trained, and then being able to train others will help a lot of women. That makes doing training appealing, but maybe it also depends on how much you enjoy teaching.
If you’re worried about the money, then donate it to PP (option E). The money will be well used, there, no doubt.
Good luck on your decision, and again, welcome back to blogland!
A – Because you genuinely believe this a good thing and therefore will benefit your patients.
You are a professional and therefore should be paid for your time.
You don’t deserve to be sent to Orlando (sorry Orlando residents, I’m sure it’s different if you live there}.
You are a professional and should be compensated for your time. You are not sending a conflicting message re: big pharma.
Show you the money!
I think that option E is the best. Everyone wins in that situation.
Regarding the thought (expressed in other comments) that you deserve to be compensated because you are an expert… Life doesn’t always work that way and it shouldn’t always be about the compensation that you will receive. I think that option E allows you to take the high road, even if there is no monetary compensation in the end. I don’t believe that you care about the money in this situation. You will more than be compensated with the outcome of your training and the women who benefit from it!
Take option A, but give the money to PP. The drug company should pay you for your time as you are a professional. It wouldn’t be appropriate for the company to get the credit for making a donation to PP. That being said, if you are uncomfortable using the money, take your check, deposit it, and donate the money to PP. This is financially equivalent to option E, but allows you to work as a professional without having to compromise your principles.
Ok: Having once turned down a job with a big pharma r&d department, I feel your pain about big pharma’s shady practices.
Option B: It’s about your ego, right? You’re not going to learn this from someone else because you’re the go to person for this stuff and ego’s important.
Option C: You might consider this. Filthy lucre is impossible to get clean.
Option D: Honey, there is no reason for penance, so forget Orlando.
Option E: No. Because if you believe in PP, you should already be donating to the cause.
That said, I think you should go with option A
Why?
Because you believe in the drug and its use and you should have training and you should be compensated for your time. That’s all.
I think you should do the training (because you know it will serve your patients), take the money (because, dammit, you’re worth it) and then make an extra donation to PPFA this year with some of it.
You can’t be a doctor and completely not associate with Big Pharma, because you are going to use their products (unless you move to CA and become a naturopathic, marijuana perscribing, ionizing, vegan doctor).
I’d rather see them give their money to you–a deserving recipient who is commited to the health and wellness (and autonomy) of women–than see them spend it on more of their terrible ad campaigns…
Good luck! Is there a training near Atlanta?!
Thanks to all for your insightful comments. Triggered a lot of thinking on my part. I decided to take the money but then to make a donation to Planned Parenthood.
The challenge for me is living in the real world, where things are not black and white, where good comes packaged with not so good, and where it’s not the “bad guys” vs the “good guys.” I think that my Catholic upbringing is still following me around more than 30 years after leaving the church, and I am still adjusting myself to a different world view. And that medicine, like politics, makes strange bedfellows.
Thanks again.
While I respect your opinion, but under this logic, why aren’t you REGULARLY giving to Planned Parenthood from your earnings as a practicing doc?
You are being asked to get training to perform a medical service, for which you get paid. You are not advocating the use of the drug direcly, you are offering a medical service to those who will need to know how to appropriately administer a device. Don’t you get paid to teach?
You could ask the academic instituion you are linked to to pay you for the time it will take to get you trained and for the training that you will give to other docs, but what do you think the response will be?
Don’t be naive. Your time and services are valuable, and you should be compensated for it. In this circumstance you are a temp employee of the company, and these are ligit expenses that THEY are responsible for and are offering to make good on that. If you didn’t take the trip and get trained, how much more money would your practice earn by seeing patients? I bet you aren’t even breaking even compared to opportunity loss.
The only thing that you need to ask yourself is whether or not the training and the compensation will directly affect the scripts you write for BC. If so, they you have to deal with that if it is right or wrong, but getting paid for your time is not only reasonable, it is mandatory.
Schtruggling:
Thanks for your comments. I already donate to Planned Parenthood.
My concerns about being paid by pharmaceuticals in relation to something that I prescribe is that it is a conflict of interest (although not a large one). I would need to report it as such to my employer, and disclose it in any meeting where I present on a topic involving the method. So, it deserves a little thought, I think.
I also know that Big Pharma uses paid “consulting” positions to influence their so-called “thought leaders”. Now usually, these “thought leaders”are folks who believe in the drug from the get-go (at least that is my experience). But big Pharma would not invest in MD Consultants unless they saw some return on that investment. So I believe it’s worth a bit of thought before I step back into the arena again. As I learn more and more about how big pharma operates and markets, I want to feel comfortable with whatever role I play in the process.
I beleive in pharmaceuticals, and inthe role that medications play in healthcare. Many lives have been saved. But there is a line between medical care and marketing that has become increasingly blurred. I seem to be spending more of my time squinting at that line trying to bring it into focus. It’s a schtruggle, but one that I enjoy thinking and talking about.
Of course you still struggle with guilt. You may have left the Church 20 years ago, but like my late husband who was also a long term lapsed Catholic, the Church hasn’t left you. Also, like him, you chose a Jewish spouse, and we too do guilt big time.
If you want a guilt free life, I’d choose Church of England, I believe you call it Episcopoalian.