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EW SHOW DAILY 20 ASCRS Symposia The way this played out, Dr. Synder said, was fortunate for Dr. Donaldson. "That's what I would have suggested for that patient because under the presumption that you're selecting these lenses because they're quality lenses and under the presumption that you're not going to do consulting for a company who makes a poor quality product, to me, it is an irrational patient who is saying 'I will only choose a product from a company you do not consult for.' It may be because those are sig- nificantly inferior products," he said. Skipping ahead a few scenarios, what obligation, if any, do clinicians have to disclose financial interests to patients? "Suppose I am a psychiatrist," said Dr. Banja, a medical ethicist and director of Emory University's Cen- ter for Ethics. "And suppose I own 100,000 shares of Pfizer stock, and suppose Pfizer makes an anti-depres- sant that I really like. I use it a lot, I trust it, I know it. Do I have to tell every patient who I write a prescrip- tion for 'I own 100,000 shares'? You wouldn't, right?" But how good of an analogy is that to the use of the femtosecond laser and disclosing interests with laser companies while discussing tra- ditional phaco surgery and laser-as- sisted cataract surgery? "I guess it depends on how much confidence you have in the technology," Dr. Banja said. A final question to the audience revealed that the strong majority felt relationships with industry are "essential to bring our patients the best technology and products." "We need to modify our own behaviors and serve as mostly inter- nal monitors to make sure that what we are doing is done in an ethical way," Dr. Donaldson said. Receiving some final words of advice from the panel on how to best work with industry, Dr. Hoffman said his motto is "the patient comes first" and Dr. Trattler said, "Innovation is a collaboration between clinicians and industry—it's a partnership." EW Editors' note: The panelists have no financial interests related to their comments. by Liz Hillman EyeWorld Staff Writer you already made the decision for the prescription because of your relationship, so there's already an ethical dilemma," he said. Off this question, the discus- sion shifted to generics versus brand name medications. Dr. Shorstein, who works for Kaiser Permanen- te, said he has not experienced any issues with generic glaucoma medications, for example, and that he thinks "our dues to our patients is to keep their premiums as low as possible and to get good care." Dr. Trattler weighed in on the generics issue, saying research has found that some generics are associated with more toxicity. "You could save more money, but maybe not with the best out- comes if you go with generic versus brand name," Dr. Trattler said. The next scenario presented involved the dilemma of a represen- tative saying he would send referrals from optometrists your way if you increased the use of his product in your practice. You: a) Agree to the deal. You like his product anyway. b) You tell him thanks but I'm al- ready so well-liked I can't imagine them liking me any more. c) Tell him you'll do the best you can to increase usage of his product, keeping this relationship in the back of your mind while making clinical decisions. d) I don't make deals. e) Other Dr. Snyder weighed in succinct- ly. "A, B, and C are illegal. You can end up in prison for that. That's not just fines, that's an orange suit," he said. Next up: "You are a consultant for a company who makes IOLs and you always use that company's IOLs. A patient wants a different compa- ny's IOL. What do you tell them?" Dr. Donaldson offered her 2 cents first with a personal anecdote. She said a patient recently came in for cataract surgery and asked if she consulted for the company produc- ing the IOL she recommended for him. Yes, she did. He, however, said he wanted an IOL from a company she did not consult for. "Now he wants a lens that I'm not working with whatsoever," she said. "He ended up going to another physician." moderator Kendall Donaldson, MD, Plantation, Florida, shared a bit about their own personal relation- ships with industry, which ranged from minimal to consulting with many companies. Going forward, Dr. Donaldson presented the panel with various scenarios, and a discussion ensued as to how they would treat that situation. For example, Dr. Donaldson presented this case about prescrib- ing habits: "You have a relationship with a pharmaceutical company that makes ABX X. So you always prescribe ABX X in preparation for surgery. However, ABX Y is much less expensive and equally good." While the majority of the audi- ence chose "other" from the list of multiple choice options, Dr. Snyder said he thinks there is an ethical dilemma just within the question itself. "If you have a relationship with a pharmaceutical company, so you always prescribe antibiotic X, then the question implies that Panel debates the ethics of the ophthalmologist/ industry relationship S eventy-one percent of attendees at a symposium sponsored by the ASCRS Cataract Clinical Com- mittee and Ophthalmology Business said they thought the rela- tionship between ophthalmologists as a whole and industry influences prescribing habits and surgical recommendations in a manner that could lead to ethical issues. A diverse panel with varying opinions shared a lively discussion on just this topic Sunday evening. The panelists, who included John Banja, PhD, Atlanta, Richard Hoff- man, MD, Eugene, Oregon, Mar- guerite McDonald, MD, New York, Michael Snyder, MD, Cincinnati, William Trattler, MD, Miami, Steve Charles, MD, Memphis, Tennessee, Neal Shorstein, MD, Walnut Creek, California, and Tuesday, May 10, 2016 Ophthalmologists and industry: An ethical dilemma or helpful collaboration? Dr. Trattler speaks about some of the ethical issues surrounding the relationship between ophthalmologists and industry, ultimately calling it a "partnership" that can lead to innovation.

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