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"?