Dr. Kassirer, thanks for agreeing to share some of your thoughts with our readers. I have to say that your book, On The Take, was one of the most powerful books I’ve read. I want to thank you for writing it!

There is trouble for the pharmaceutical industry in CME City. The ACCME (Accreditation Council for Continuing Medical Education), which sets national standards for accredited CME activities, has tightened up its requirements for commercial support, which is giving drug companies, private medical education firms, and assorted hired guns a collective case of indigestion.

Many readers have wondered why I decided to publish The Carlat Report. Well, back in the day, I was a member of the speaker’s bureau of four pharmaceutical companies. I would typically travel to the offices of primary care physicians nearby and talk up the sponsor’s drug.

1992 was a very big year in the history of the relationship between the FDA and the pharmaceutical industry. That year, Congress passed the Prescription Drug User Fee Act (PDUFA), allowing the FDA to charge pharmaceutical companies hundreds of thousands of dollars per drug for the drug approval process.

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Here’s a scenario for you. You have five medications to choose from. They are all FDA approved for the same indications. Any head-to-head study among them has shown equivalent efficacy. Three of them are associated with significant weight gain, hypercholesteremia, and diabetes risk. Two of them are not. Your job is to take a stand on what you would recommend as "first-line" medication for the disorder in question.