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Dr. Wei-Yi Song’s letter “Don’t freeze specialists out of guideline development” [1] outlines the Canadian Psychiatric Association’s concerns regarding Jatoi and Sah’s March 18, 2019 Commentary recommending guideline reform. [2] In Dr. Song’s view, "The simplistic conclusion that specialist physicians recommend more interventions and care because they make more money doing so is shockingly unscientific and denigrating...."
We think it is worth re-reading the Commentary, since it explains in part how fee-for-service conflicts may arise, and points out how difficult it seems for physicians or others in helping professions to recognize them. There is ample evidence that physicians who "interact" with the pharmaceutical industry prescribe more expensive drugs, request more new drugs be added to hospital and community formularies, and prescribe less rationally [3,4,5] than doctors who shield themselves from such biases. It is well recognized that prescribers who "interact" with the pharmaceutical industry believe themselves immune to these effects [3]. The industry knows better and spends its marketing dollars wisely from a business perspective. Failure to acknowledge one’s own biases is well known to the social sciences and an important basis for the success of advertising. [6,7]
Dr. Song contends that "Guidelines developed by non-specialists and that are based solely on clinical trial data may oversimplify treatment and...
Show MoreCompeting Interests: Aaron M Tejani Paid by Lower Mainland Pharmacy Services (Fraser Health BC), and Therapeutics Initiative (UBC) Received honoraria from Local and Provincial clinician Groups for presentations given (e.g. West kootenay Division of Family Practice) Received honoraria from the Guidelines and Protocols Advisory Committee, Doctors of BC Thomas L Perry Paid by Therapeutics Initiative (UBC) Worked from 2008-2018 as a consultant to US and Canadian litigation alleging improper or fraudulent marketing by 5 major pharmaceutical manufacturers