The Speakers’ Bureau System: A Form of Peer Selling

Physicians need to stay abreast of information about emerging drugs and devices, but the time pressures of clinical practice may limit their ability to do so independently. The companies that manufacture and sell these products have the resources and the motivation to “educate” physicians but cannot be expected to distinguish their marketing goals from physicians’ educational needs. Physicians’ professional associations and regulatory bodies, as well as medical journal publishers and editors, drug and device regulatory agencies, and academic medical institutions, have long debated their respective roles and responsibilities in ensuring the safety, efficacy, and probity of prescribing in light of these pressures and interests. One current context of this long-standing struggle is the “speakers’ bureau” system, in which pharmaceutical, biotechnology, and medical device companies recruit and train physicians to deliver information about products to other physicians, in exchange for a fee or other considerations, such as professional development opportunities. Participants in the system argue that physicians are best situated to deliver accurate information about new drugs and devices to other physicians and that industry is best placed to fund such communication. Critics reply that the speakers’ bureau system raises significant concerns about ethics and professionalism and that it is part of a complex system of drug promotion and relationship-building with physicians that contributes to irrational prescribing, inflated health care costs, and even harm to patients or society more generally. Some steps have been taken toward limiting participation in speakers’ bureaus. The American Association of Medical Colleges (AAMC), in a report endorsed by the Association of Faculties of Medicine of Canada (AFMC), has stated that faculty participation in speakers’ bureaus should be strongly discouraged and that faculty, residents, and students should be prohibited from attending such events. Furthermore, in the United States, lawsuit settlements and health care reform (i.e., the Physician Payment Sunshine Act, passed as a part of the Patient Protection and Affordable Care Act) are bringing some transparency to speakers’ bureau arrangements