WEDNESDAY, April 25, 2007 (HealthDay News) -- The ties between doctors and drug manufacturers are close indeed, with virtually all doctors reporting some kind of relationship with industry, even if it's as seemingly innocuous as accepting free food and beverage, a new study has found.
But the relationships vary depending on the kind of medical practice and specialty, the patient mix and the professional activities of the physician, according to the study, published in the April 26 issue of the New England Journal of Medicine.
Over the past two decades, physician-industry relationships have attracted increasing scrutiny. One review found that, on average, physicians meet with industry representatives four times a month, and medical residents accept six gifts annually from industry representatives.
Earlier this year, a group of influential doctors and academic leaders, including the senior author of the new study, called for a ban on all pharmaceutical gifts to doctors at academic medical centers, among other actions.
The outcry has been such that certain professional and industrial organizations, such as the Pharmaceutical Research and Manufacturers Association of America (PhRMA), have adopted new guidelines.
For this study, the authors surveyed 1,162 physicians in six specialties in late 2003 and early 2004 to find out what they received from the drug industry, how often they met with industry representatives and what factors were associated with the frequency and type of physician-industry relationships.
The six specialties were anesthesiology, cardiology, family practice, general surgery, internal medicine and pediatrics.
Most physicians (94 percent) reported some type of relationship with the pharmaceutical industry. Most of these relationships involved receiving food in the workplace (83 percent) or receiving drug samples (78 percent).
More than one-third of the respondents (35 percent) were reimbursed for costs associated with professional meetings or continuing medical education, while more than one-quarter (28 percent) were paid for consulting, delivering lectures or enrolling patients in clinical trials.
Cardiologists were more than twice as likely as family practitioners to receive payments, although family practitioners met more frequently with industry representatives than did physicians in other specialties.
Doctors in solo, two-person or group practices met more frequently with industry representatives than did physicians practicing in hospitals and clinics.
PhRMA senior vice president Ken Johnson responded to the study in an official statement. "Sales representatives -- many of whom are health-care professionals themselves -- are prepared to answer the questions of health-care providers about the benefits, proper use and side effects of drugs. To help make sure the information they provide is accurate and well-substantiated, the reps must comply with strict Food and Drug Administration regulations. Additionally, PhRMA provides voluntary marketing guidelines -- contained in the Code on Interactions with Healthcare Professionals -- to provide guidance on how to maintain ethical relationships with physicians and other health professionals. In the end, pharmaceutical marketing is one of several important ways for health-care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated."
The study authors expressed concern, however, about how these ties might affect patient care.
"We know that these relationships have benefits and risks, and we know that they benefit the companies that are involved, and we know from our data that they benefit doctors," said study author Eric G. Campbell, an assistant professor of health care policy at the Institute for Health Policy at Harvard Medical School and Massachusetts General Hospital in Boston. "The real question is to what extent do these relationships benefit patients, and the answer is, we don't know."
Campbell said that he found it hard to believe that free football tickets for a doctor would trickle down to benefit patients, although he did point up the need for more research.
"We need to look for things like whether doctors who have a relationship with a company are more likely to prescribe drugs made by the company, or brand names rather than generics," he said. "That's the next step, and, until we get there, we're just not going to know."
The American Medical Association has more on medical ethics.
SOURCES: Eric G. Campbell, Ph.D., assistant professor of health care policy, Institute for Health Policy, Harvard Medical School and Massachusetts General Hospital, Boston; April 24, 2007, statement of Ken Johnson, senior vice president, Pharmaceutical Research and Manufacturers Association of America, Washington, D.C.; April 26, 2007, New England Journal of Medicine
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