Physicians Practice - January 2008 - (Page 41)

the American College of Physicians. “Though they are trained as a physician and are certainly able to give injections, it is my feeling that those kinds of treatments are best handled by specialists, like dermatologists.” Many, too, fear physicians who supplement their incomes by testifying as expert witnesses in malpractice lawsuits may be tempted to give false or misleading testimony. They also suggest physicians could end up spending too much time in court and too little time literally practicing what Advocates of community-based research say such studies keep the medical community abreast of cutting-edge research and provide patients with potentially lifesaving treatment options. Though physician investigators are paid by the trial sponsors (often drug companies), reports that clinical trials are a cash cow are grossly overstated. Most receive fair and reasonable compensation for their efforts. Indeed, a 2006 CenterWatch survey found nearly half of physicians who enter the research KNOW YOUR STUFF “You should always receive adequate training and perform enough procedures to keep current.” Terry McGeeney, president, TransforMED they preach. Noting that, “when appropriate, physicians have an obligation to testify in court as expert witnesses,” the American College of Surgeons has issued ethics guidelines to encourage physician expert witnesses to remain impartial in legal proceedings. The organization also launched a nationwide database of expert witness testimony to keep physicians in check. “Because itinerant plaintiff expert witnesses who provide inappropriate and inaccurate testimony are still commonplace, there is a need for an expanded and comprehensive database to track such testimony,” the College wrote in 1997, when the database debuted. Clinical trials are under the same scrutiny. According to CenterWatch, a Boston-based publishing ﬁrm that tracks the industry, nearly half of the 7,300 physicians it surveyed from the Physicians Desk Reference were actively engaged as clinical investigators in 2005. WWW.PHYSICIANSPRACTICE.COM ﬁeld and remain involved in trials rank professional development, interest in research, and a drive to improve patient care as key motivators. Only 9 percent of investigators cite money as a reason to participate. Still, critics remain concerned over the money physicians receive to enroll their patients in clinical trails. Such payments, they argue, present a conﬂict of interest — encouraging doctors to exploit patients who don’t necessarily ﬁt the research protocol. “A doctor who does legitimate research for drug companies has a right to be reasonably reimbursed for any additional work they do,” says Peter Lurie, a medical doctor and deputy director of the health research group at Public Citizen, a Washington-based watchdog group. “The problem is that sometimes the incentives for doctors to participate in a trial are ridiculously large for the amount of work they do.” According to the American College of Physician’s Fifth edition Ethics Manual from 2005, functioning as both an investigator and the clinician of a patient-subject can also result in conﬂict between what is best for research and what is best for the patient: “Physician-investigators should disclose this conﬂict to potential research participants and should maintain patient-subject health and welfare as their primary consideration,” the manual states. “Patients should be informed that the primary motive of a research protocol is to gain new knowledge and that there may or may not be clinical beneﬁt.” Also, disturbing to some are the increasingly aggressive sales tactics used by pharmaceutical ﬁrms to encourage participation, offering doctors a premium to enroll many patients quickly. And few in the medical ﬁeld support so-called “seeding trials,” in which drug companies pay doctors to gather supporting data on patients after a product is released. Such trials, they say, are designed to expose more doctors to the drug and are often initiated by marketing departments. “Well-designed and well-controlled clinical trials are a very valuable activity for society, but I think too often clinical trials are done with new drugs that are very similar to old drugs so there is not much expectation that there will be a unique beneﬁt,” says Dale. “That’s of lesser value.” Before embarking on a clinical trial, he says, physicians should explore whether it is a good investment of their time and gather thoughts from colleagues on the merits of such research. “Think about it as something that has a lasting value and not just a revenue stream for the ofﬁce,” says Dale. AN IMAGE PROBLEM Though private practitioners have been forced to tap their inner entrepreneur, there is one other factor that weighs heavily on their JANUARY 2008 | PHYSICIANS PRACTICE | 41 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - January 2008

Physicians Practice - January 2008 Contents The Bigger Picture: Fixing Medicaid Letters Physicians Practice Pearls: You Can Teach an Old Dog New Tricks Noteworthy Cover Story: Fee Schedule Survey: 2007 Results Adding Ancillaries: Bucking the Practice Ask the Experts Idealab: 'How I Got Over My EMR Excuses' Technology: Don't Be Denied The Tech Doctor: Blessing or Curse? The Administrator's Desk: Learning From the Best Coding Career: To Partner, or Not? Management: Controlling Your Inventory Human Resources: How to Fire an Enployee Finance: Beyond Reimbursment - How to Fix Your Mix Classifieds Advertiser Index

Physicians Practice - January 2008

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