January 25, 2006|By JULIE BELL | JULIE BELL,SUN REPORTER
Through giveaways and sponsorships, the mamanufacturers of drugs and medical devices can distort the way doctors care for patients, a group of prominent physicians and scientists warns today in a call for reforms.
The group recommends that academic medical centers ban some common practices, regulate others and make a concerted effort to disclose doctors' financial relationships with makers of drugs and devices.
"Marketing and market values should not be allowed to undermine physicians' commitment to their patient's best interest or to scientific integrity," the authors contend.
The group of 11 - from Harvard, Columbia and Tufts universities, among other institutions - calls for the reforms in a special communication in today's Journal of the American Medical Association.
Although the article was not timed to coincide with any event, the authors point to recent congressional investigations, prosecutions and class action lawsuits that have buffeted the medical profession.
Yesterday, The New York Times reported that Medtronic Inc., a manufacturer of medical devices, had paid individual physicians hundreds of thousands of dollars in consulting fees.
In the JAMA report, the authors argue that doctors should no longer accept gifts from companies that make drugs or medical devices, take free samples from pharmaceutical representatives or accept "no-strings" grants.
Pharmaceutical firms should continue to sponsor specific research, Dr. Troyen A. Brennan of Harvard and his co-authors say, but academic medical centers should act as brokers when companies want to make unconditional grants. The institution should dole out the money as the university - not the company - sees fit.
Relationships between the industry and physicians, the authors say, should be publicly disclosed on the Internet.
"The serious threat that this state of affairs poses for professionalism, and for the trust that patients have in physicians, makes the need for effective guidelines on industry-physician relationships both apparent and urgent," the authors contend.
Catalyst for debate?
The paper announces no new research. But two of the authors say they hope it will be a catalyst for debate on the role of academic medical centers in safeguarding patient trust.
Voluntary guidelines by a drug industry group, professional associations and the government have not stemmed abuses, the authors say, and academic medical centers need to step into the breach.
"My mother told me never to accept a gift from strangers," Dr. Jordan J. Cohen, a co-author of the article, said in an interview. "And for good reason: When strangers give you gifts, they expect something in return."
Cohen, president of the Association of American Medical Colleges, said he would bring the recommendations before its governing body next month but was not representing the organization when he signed the article.
The Pharmaceutical Research and Manufacturers of America issued a statement noting that it has a voluntary code that says "entertainment, expensive meals and gifts that are for personal use by the physician are not appropriate."
But the industry group appeared to take issue with the authors' call for a more-distant relationship between sales representatives and doctors.
"Sales representatives are well-trained technically and are prepared to answer doctors' questions about drugs, their side effects and how they work," the group said.
The authors of the JAMA article call for an end to no-strings consultancies, in which companies pay doctors without requiring them to provide advice or expertise on specific issues. Such arrangements are "tantamount to a gift and should be regarded as such," they argue.
The Johns Hopkins School of Medicine requires faculty members to disclose all consulting contracts and reviews them "to make sure it's substantive and not merely window dressing for payments," said Julie Gottlieb, assistant dean for policy coordination.
She said the school wants to prevent companies from buying doctors' loyalties and using them to market products.
In a statement, the American Medical Association said its guidelines call on physicians to avoid industry ties that might cloud their judgment on treatment decisions. The policy does not bar doctors from receiving gifts from pharmaceutical firms.
"The guidelines state that physicians should accept only gifts that entail a benefit to patients and are of modest value, and no gift should be accepted if there are strings attached," said Dr. Duane M. Cady, the AMA's president.
Psychiatrist John Talbott, a professor at the University of Maryland School of Medicine, praised the recommendations in the JAMA article.
"I think university medical centers should take the lead, absolutely," said Talbott, who is overseeing a project to teach the school's medical students about ethics and professionalism. "We should be the leaders in setting the rules."
The medical profession, he said, is responsible for its own ethics.
