Doctors should not accept drug samples, junkets or even ballpoint pens from drug or medical-device companies, says a group of leading physicians and scholars in a sweeping new call for ethical reform in medicine.
In today’s Journal of the American Medical Association, 11 experts warn that the financial ties between physicians and drug and device vendors are undermining scientific integrity and patient care.
The authors labeled existing guidelines ineffective, and called on university-affiliated hospitals to take the lead in establishing stricter policies that would bar gifts, restrict corporate financial ties and require transparency in medical research contracts.
The recommendations mark the first high-profile effort from within the medical profession to broadly limit financial entanglements between doctors and companies. Authors said doctors must embark on reforms or face increased government regulation.
“If you don’t do it, it’s going to be done to you,” warned David Rothman, a co-chairman of the group who also is president of the Institute on Medicine as a Profession at Columbia University.
The pharmaceutical industry alone spends about 90 percent of its $21 billion marketing budget on efforts aimed at physicians, the JAMA article’s authors said. That’s an average of $13,000 a year per doctor – an outlay that the authors contend drives up the cost of medications and affects what gets prescribed.
“It’s clear that voluntary disclosure is not working and even small gifts can influence behavior,” said group co-chairman Dr. Troyen Brennan, a Harvard professor of medicine who last week was appointed chief medical officer of Aetna Inc.
Concerns about the influence of marketing on medical decisions have been on the rise, fueled recently by courtroom revelations about Merck &Co.’s lobbying of physicians for its now-banned blockbuster pain reliever Vioxx.
JAMA editor Dr. Catherine DeAngelis said she expects the new recommendations to stir controversy but views the debate as vitally important to patients.
“There’s some recommendations in there that I think are excellent,” she said. “Whether all or some of them will be enacted … I don’t know. I certainly hope that they would be.”
Among other recommendations, the authors said teaching hospitals should:
* Bar doctors from serving on manufacturers’ speakers bureaus or participating in articles ghostwritten by industry-paid authors.
* Exclude physicians who have ties to manufacturers from committees that decide what drugs and devices will be allowed at hospitals.
* Prohibit open-ended grants and gifts to physician researchers and post all consulting and research contracts on a public Web site.
Drug industry officials say doctors should be careful not to go too far. Pharmaceutical sales representatives provide information that ensures medications are used correctly and answer questions about how their drugs work and side effects, they say.
And a voluntary code adopted by the Pharmaceutical Research and Manufacturers of America three years ago works fine, said Ken Johnson, a senior vice president with the trade group.
“The code states that entertainment, expensive meals and gifts that are for personal use by the physician are not appropriate,” he said in a statement. “Only practices that do not compromise independent judgments of health providers, such as modest working meals, gifts of minimal value that support medical practice and distribution of free samples, are permitted.”
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