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An independent future for Medicine in the United States?
Published in JAMA, a panel of leading physicians recommended far-reaching conflict-of-interest policies, aimed at separating the relationships between pharmaceuticals and doctors.
The group said that voluntary efforts to limit corporate inducements have failed, resulting in the overprescribing of some medications and the withholding of negative discoveries about others. Highly publicized cases involving the anti-inflammatory drug Vioxx, antidepressants for children and spinal implants made by Medtronic -- all occurring while voluntary guidelines were in place -- highlight the need for stricter measures.
Spokesmen for the pharmaceutical industry said the extra steps are unnecessary and could deprive physicians of valuable information. Although most doctors say their relationships with drugmakers do not affect medical decisions, numerous studies suggest otherwise.
Modest gifts such as lunch or pens may persuade a doctor "to listen to the presentation of information, not necessarily to prescribe that product." And having those discussions over a "working meal" is merely a timesaver for busy doctors, he said.
But the JAMA authors said it is a costly mistake to confuse marketing with scientific data. "Drug companies spend $13,000 per physician annually," said co-author David J. Rothman, a professor of social medicine at Columbia University Medical Center. "Those marketing tactics are very, very effective at getting physicians to do what each drug company wants -- to prescribe their product."
The team conducted focus groups with doctors who "came right out and said if one drug rep is nicer than another, I'm going to prescribe that person's drug, all else being equal," said co-author David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital. In a second article, Blumenthal found that conflicts of interest have contributed to growing secrecy in research, with some scientists intentionally omitting negative findings about a drug or device.
Rather than severing all ties to the pharmaceutical industry, the panel suggested creating financial firewalls. Instead of paying a physician directly for continuing medical education, it would be more appropriate for drug companies to contribute to a central account that supported educational programs, they wrote. In addition, payments for outside work such as speeches or consulting should be explicitly defined and posted on the Internet.
Finally, the group urged the nation's 125 medical schools and affiliated hospitals to refuse drug samples and instead create a voucher system or central distribution bank for poor patients.
Published in JAMA, a panel of leading physicians recommended far-reaching conflict-of-interest policies, aimed at separating the relationships between pharmaceuticals and doctors.
The group said that voluntary efforts to limit corporate inducements have failed, resulting in the overprescribing of some medications and the withholding of negative discoveries about others. Highly publicized cases involving the anti-inflammatory drug Vioxx, antidepressants for children and spinal implants made by Medtronic -- all occurring while voluntary guidelines were in place -- highlight the need for stricter measures.
Spokesmen for the pharmaceutical industry said the extra steps are unnecessary and could deprive physicians of valuable information. Although most doctors say their relationships with drugmakers do not affect medical decisions, numerous studies suggest otherwise.
Modest gifts such as lunch or pens may persuade a doctor "to listen to the presentation of information, not necessarily to prescribe that product." And having those discussions over a "working meal" is merely a timesaver for busy doctors, he said.
But the JAMA authors said it is a costly mistake to confuse marketing with scientific data. "Drug companies spend $13,000 per physician annually," said co-author David J. Rothman, a professor of social medicine at Columbia University Medical Center. "Those marketing tactics are very, very effective at getting physicians to do what each drug company wants -- to prescribe their product."
The team conducted focus groups with doctors who "came right out and said if one drug rep is nicer than another, I'm going to prescribe that person's drug, all else being equal," said co-author David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital. In a second article, Blumenthal found that conflicts of interest have contributed to growing secrecy in research, with some scientists intentionally omitting negative findings about a drug or device.
Rather than severing all ties to the pharmaceutical industry, the panel suggested creating financial firewalls. Instead of paying a physician directly for continuing medical education, it would be more appropriate for drug companies to contribute to a central account that supported educational programs, they wrote. In addition, payments for outside work such as speeches or consulting should be explicitly defined and posted on the Internet.
Finally, the group urged the nation's 125 medical schools and affiliated hospitals to refuse drug samples and instead create a voucher system or central distribution bank for poor patients.
