By LEE BOWMAN
Scripps Howard News Service
January 25, 2006
Their paper, published Wednesday in The Journal of the American Medical Association, urges academic medical centers to abolish or strictly limit gifts and payments from drug companies that might unduly influence physicians.
"The essence of our proposal is to build a firewall between drug companies and medical practitioners," said David Rothman, president of the Institute on Medicine as a Profession, a New York think tank that studies issues of medical professionalism, and co-chair of the group that wrote the proposed guidelines.
Relationships between drug companies and doctors have been under a darkening ethical cloud in recent years, with disturbing disclosures about what the annual average of $13,000 the drug industry spends per doctor in marketing products has gone toward.
While doctors tend to insist that their prescribing habits aren't influenced by freebies, Rothman said, "the data are overwhelming from numerous studies of these things. Gifts, travel grants, consulting contracts, support for continuing medical education and speaking fees do affect which drugs doctors prescribe for their patients."
While medical-research journals increasingly demand that doctor-scientists fully disclose any ties they have to companies that might benefit from a study, doctors seldom if ever disclose that they've gotten gifts or consulting fees from drug or medical-device firms.
"It's clear that voluntary disclosure is not working and even small gifts can influence behavior," added Dr. Troyen Brennan, co-chair of the working group and president of the Brigham and Women's Physicians Organization in Boston.
But the committee also recognizes that some relationships between drug companies and medical researchers are beneficial to the public.
"If the ties were entirely nefarious, it would be easy to keep them all out, but there is a lot of good research that produces good drugs that you need to have the top medical experts and medical centers engaged with, so you don't want to sever all those ties," Rothman said.
"So we don't say ban them, but make them transparent to everyone, the school, colleagues and patients, so that if you go to a guy for back surgery, you know he's collected $700,000 from a device maker."
The experts group, which was also supported in its two-year review by the American Board of Internal Medicine Foundation, focused on tightening rules at the nation's some 125 academic medical centers. That is because those hospitals "are where the opinion leaders research and practice. That's why the drug companies target them."
But teaching hospitals are also being squeezed for money in an era of increasing competition and moves toward controlling costs, along with shrinking federal subsidies for medical education.
Thus, the committee suggested that if drug companies wanted to keep providing money to support continuing medical education and travel, they should contribute to a central fund administered by the health center, which would dole out money to faculty and training-program directors.
"Of course, some companies may say that's charity, not marketing, and these changes may hit some physicians in the pocket," Rothman conceded. "It may be a difficult sell in this economic climate, but no less difficult than the problems that these open-ended relationships with drug companies bring. We are saying to academic medical centers: 'Clean up your act. If you don't, others will.' "
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