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Monday, November 28, 2005

New trend in drug company CME sessions?FP docs as the experts.

Three times in the last 4 months I have attended the typical drug company sponsored evening CME held at nice restaurants at which the subject matter expert presenting the talk was a family practice physician. One was on Bipolar disease and it was interesting how many bipolar patients this FP doc had apparently treated. The topic of another talk was BPH and 2 FPs shared the stage.One interestingly mentioned that he had not had a chance to "go over" the slides prior to his talk making the skeptical among us wonder who wrote the script.This talk was given around Nov 3, 2005. In March of this year there were reports of IFIS ( intraoperative floppy iris syndrome) occurring in patients treated with tamsulosin, a popular alpha blocker. Much of the discussion at the meeting was about alpha blockers and their side effect profiles.By October,Health Canada was warning opthalmologists of this entity and to inquire specifically if their pre op patients were on alpha blockers. I make this point because neither of the speakers mentioned this even though there was a very detailed presentation of side effects with the apparent emphasis being that the alpha blocker of the sponsoring company seemed most side effect free. The Health Canada site indicated they at that time the drug manufacturer of the implicated medication (tamsulosin) was working on a notification letter to doctors, so one could assume that the drug companies manufacturing this class of drugs were aware of the issue at least by October 2005 and more likely much sooner than that.This lapse in full disclosure will not likely occur in the future as on November 22 The FDA and tamsulosin's manufacturer issued a physician warning about the floppy iris issue.
It is interesting that family docs are now the experts for some of these talks.A urologist is likely to see many more cases of BPH and have much more experience in the vagaries of day to day assessment and treatment than would a FP physician.Further,urologists have only to be current in urology while FP have the Herculean task of keeping up with just about everything and if for no other reason than that less likely to be expert in anything. So why are they chosen to speak about certain topics to a group that typically consists of FPs,NPs and internists? Maybe they believe that if primary care docs listen to another primary care doctor who is apparently very comfortable in managing bipolar patients,they will have fewer qualms in prescribing the latest atypical antipsychotic medication for the next bipolar patient. Is the message crafted to be "we, primary care doctors, do not need to refer bipolar and BPH patients to the psychiatrists and urologists , we will just prescibe drug x and drug y"?


Anonymous said...

I think in certain areas of the country, primary doctors are the psychiatrist and urologists of the community. There is such a shortage in psychiatric care that a good primary care physician should be able to recognize and treat bipolar disorder. They should be able to recognize which disorders should be referred to a specialist and which should be followed closely.

Clinical Cases and Images said...

It seems like the new mnemonic is "F" x 3:

F lomax
F low improvement (urine)
F loppy iris (63% of patients)

Anonymous said...

I tend to agree with the first comment. I live in a major metropolitan city, and there is access to multiple specialists. However, they are truly not accessible, and most of the two diseases mentioned (BPH and Bipolar) goes to the PCP's office, not the urologist or psychiatrist. I believe that an FP who gave a talk should be given the respect of another MD, despite not being a "specialist" of anything. The typical FP sees 25 per day, and more than 50% is psych.