I write this blog on an Amtrak train from Philly to Washington, returning from one of the occasional roundtable discussions ACP leadership has with representatives of the pharmaceutical industry. We had a lively discussion of issues of concern to both physicians and drug manufacturers, such as improving care of patients with chronic diseases, the patient centered medical home, primary care workforce, and comparative effectiveness research.
Reaching out to other stakeholders, including pharma, is an important part of my job. Sometimes, such discussions enable us to weigh in on the same side of public policy issues, with greater clout than either could bring on our own.
Other times, we end up agreeing to disagree. For instance, pharma generally opposes including cost-effectiveness in evaluations of the relative effectiveness of different drugs and medical treatments, while ACP believes it is important to consider both clinical efficacy and cost-effectiveness. ACP does not favor direct-to-consumer advertising (and we call for greater regulation to the extent it is permitted), while the pharmaceutical industry obviously supports it with lobbying and advertising dollars.
Still, I think it is better to understand our differences than to take positions uninformed by the views of the others.
Discussions among multiple stakeholders have taken on a heightened importance as the country takes up health care reform. ACP is involved in several different forums to explore the possibility of achieving a health care reform consensus among physicians, health plans, consumers, businesses, pharma, health plans, and others. The thinking is that agreement among such diverse but powerful interest groups - call us strange bedfellows, if you will - could be a breakthrough event for health care reform. The alternative is for each stakeholder to duke it out, recognizing that any one of us might have the power to block health care reform to protect our own respective interests.
I recognize that some internists have a very negative view of pharma. It is not unusual for ACP members to approach me at chapter meetings to vent - with a great deal of passion - about the high cost of prescription drugs. Some internists go as far as to advocate that ACP sever all ties with pharmaceutical manufacturers.
On the other hand, there are many ACP members who recognize the importance of pharma in developing new drug therapies and providing appropriate sponsorship and unrestricted grant support for medical education and research on quality improvement. It also is not uncommon to find ACP members in senior management positions within pharmaceutical companies.
ACP's leadership generally believes that it is better to seek a shared understanding with the pharmaceutical industry (and other health care industries) than to close off dialogue. Certainly, we have to guard against being co-opted by any industry group. We have to speak clearly for the interests of ACP members and their patients when they collide with those of industry. But I believe that respectful dialogue among all those with a stake in health care reform is healthier than categorizing each other as friend or foe.
Today's questions: What do you think - should ACP try to find common ground with drug manufacturers on public policy issues? Where do you see us having shared interests - or potentially irreconcilable differences?