January 25, 2006|By JULIE BELL | JULIE BELL,SUN REPORTER
"One of the characteristics of a profession is self-government," he said. "We have to be scrupulous to keep that trust."
Talbott said studies have shown that doctors' medical decisions are affected when they accept gifts from companies. "You have to go on what the science shows," he said.
Dr. Marcia Angell, a former editor in chief of The New England Journal of Medicine, said she was "delighted" that a working group of influential thinkers had weighed in, noting that many of their recommendations mirror points in her book The Truth About the Drug Companies.
But "there is a lot of weight on the other side, in terms of just the sheer amounts of money, so I think it's going to be very hard to roll back the wholesale bribery that goes on," Angell said. "My hope is ... that it will make academic medicine ashamed of itself."
Dr. Adil E. Shamoo, a University of Maryland professor who teaches research ethics and edits the journal Accountability in Research, said the guidelines proposed in the JAMA article fall far short of what is needed.
"That's the fox guarding the henhouse," he said of the notion that academic medical centers - which also stand to benefit from the money from drug and device makers - would act as independent brokers. "This is totally unworkable and with gaping holes, so its worthiness is in doubt."
The authors of the JAMA article include Brennan, a Harvard professor of medicine, law and public policy who has studied and written about medical professionalism; Dr. David Blumenthal, a Harvard professor of medicine who has written about doctors and drug companies; and Dr. Jerome P. Kassirer, a Tufts University distinguished professor of medicine and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.
The research was sponsored by the ABIM Foundation, a nonprofit that takes its initials from the American Board of Internal Medicine and is devoted, in part, to supporting medical professionalism; and the Institute on Medicine as a Profession, a nonprofit funded by financier George Soros that conducts its research through Columbia University appointees and has a similar focus.
Common practices
The JAMA special communication - essentially a long opinion piece with footnotes - criticizes many of the ways drug and device makers commonly market products to physicians.
Studies have shown that even small gifts can influence behavior because of recipients' desire to reciprocate, the authors of the JAMA article note.
The article takes issue with widely accepted practices that include allowing companies to sponsor and pay for the continuing education courses that physicians must take to keep their licenses.
The authors also take aim at the practice of allowing drug company salesmen to pay calls on doctors to hand out free samples.
"The purpose behind such industry contacts is unmistakable: Drug companies are attempting to promote the use of their products," the authors write.
They suggest that samples instead be distributed in a way that keeps drug company representatives at arm's length from physicians.
One proposal would give low-income patients vouchers that they could present for free samples, although the authors don't spell out how that would work.
Other suggestions include barring physicians with financial relationships with drugmakers from hospital and medical committees that decide which drugs to prescribe.
Such recommendations, the article acknowledges, are likely to be controversial because they deal with practices that financially benefit physicians and drug companies.
Brennan said he hopes the proposals spark discussion.
"I'd be happy if they debate the issue and come up with a different set of proposals," he said.
David J. Rothman, a Columbia University professor of social medicine and president of the Institute on Medicine as a Profession, said in an interview that recent scandals make the timing right for reforms.
"This is the right thing to do," Rothman said. "Academic medical centers ought to do it in the best spirit of professionalism. Given what's going on out there, if they don't do it, there's a good chance it will be done to them."
juliana.bell@baltsun.com
Sun reporters Jonathan Bor and David Kohn contributed to this article.
Seeking changes
A group of prominent physicians and scientists has called for reforms in how doctors deal with makers of drugs and medical devices. Here are some of the changes they seek:
An end to "no-strings" payments from makers to doctors
Replacing free handouts of drug samples to doctors with a system that would put the medicines in the hands of patients who can't afford them
Barring doctors with financial relationships with drugmakers from hospital and medical association committees that decide which drugs to prescribe
Disclosure of "consulting" contracts between doctors and makers
An end to drug companies sponsoring and paying for the continuing education courses physicians must take to keep their licenses
