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Group Calls for Ban on Drug-Industry Gifts to Doctors

Goal is to ensure that patients' best interests come first, advocates say

TUESDAY, Jan. 24, 2006 (HealthDay News) -- A group of influential doctors and academic leaders are calling for a ban on all pharmaceutical gifts to doctors at academic medical centers.

The plan also calls for stricter tabs on pharmaceutical support to continuing medical education activity and to research, as well as a stop to free samples. The reforms are intended to resurrect and maintain the integrity of medicine and medical professionals, the sponsors said.

"Gifts require reciprocity. Docs say they can't be bought but each time you get a gift, ultimately it does affect what you prescribe," said David J. Rothman, president of the Institute of Medicine as a Profession at Columbia University, New York, and co-chairman of the committee that wrote the recommendations.

"We want to make certain that it's scientific knowledge and patients' best interest, not reciprocity, conscious or unconscious, that underlies doctors' prescribing," he added.

David Magnus, co-director of the Stanford University Center for Biomedical Ethics, said, "It's a fantastic idea. There's huge amounts of empirical evidence that lower gift amounts have an influence dollar-for-dollar, disproportionately even greater than large gifts. You probably get a lot more bang for your buck with small gifts. If it's unethical at high dollar amounts to buy influence and it has the same impact at lower amounts, it seems inescapable to conclude that you can't have it at any dollar amount."

Supporters of the reform include Dr. Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine; Dr. Jordan Cohen, president of the Association of American Medical Colleges; and Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital.

The recommendation appears in the Jan. 25 issue of the Journal of the American Medical Association.

Gift-giving and other support is a significant part of the pharmaceutical industry and much of it is focused on physicians. About 90 percent of the $21 billion marketing budget of the pharmaceutical industry continues to be directed at doctors, the study stated.

And, according to an earlier study, even third-year medical students receive, on average, one gift or attend one activity sponsored by a drug maker each week.

Now, however, such practices are coming under increased scrutiny.

"We know more about drug-company marketing practices," Rothman said. "Drug companies are more and more powerful, more and more energetic in terms of their marketing. Now we have the data that these gifts matter, these company practices matter."

The working group spent two years looking at industry marketing practices and papers detailing the effects of marketing on physician decision-making.

The new recommendations target academic medical centers because they "should provide leadership for medicine in the United States," the authors stated.

In addition to a total ban on gifts, including free meals, the group recommends:

  • A ban on providing drug samples to physicians. A system of vouchers for low-income patients or some other system of indirect distribution could take its place.
  • A ban on manufacturers' providing support, direct or indirect, to continuing medical education activities. A centralized fund should be established for manufacturers to contribute funds for physician travel or consulting, so doctors would be insulated from influence by any one donor.
  • Doctors with financial relationships with drug companies should not participate in hospital and medical group formulary groups or committees overseeing purchases.
  • Academic medical center faculty should not serve as members of speakers bureaus for drug or device makers, nor should they publish articles or editorials ghostwritten by industry employees.
  • Open-ended grants and gifts should be prohibited. Terms of consulting and research contracts should be posted on a publicly available Web site to promote more transparency. Disclosure of financial relationships, the authors stated, is not sufficient to eliminate conflicts of interest.

Rothman hopes the article will motivate others to take up the cause.

"Our hope is that when one of the two most prestigious medical journals publishes this, we will arm the group that's on our page," he said. "There are folks out there already with us. We're hoping that they will be able to use this publication as a way of getting the movement moving along."

The timing may well be right.

"I think this will be the norm at major tertiary care hospitals," Magnus said. "It will take a lot longer to penetrate private clinics and private practices but we're very much on our way."

In response to the article, Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, issued a statement that said: "PhRMA and its members share JAMA's concern that patient care be based solely on the needs of each patient and a physician's medical knowledge and experience. For more than three years, PhRMA has had a voluntary code to help make sure that member company interactions with health care providers focus on providing useful information about a company's medicines. The code states that entertainment, expensive meals and gifts that are for personal use by the physician are not appropriate.

"Only practices that do not compromise independent judgments of health providers, such as modest working meals, gifts of minimal value that support the medical practice and distribution of free samples, are permitted," he added.

More information

To learn more, visit the Institute on Medicine as a Profession.

SOURCES: David J. Rothman, Ph.D., president, Institute on Medicine as a Profession, and professor of social medicine, Columbia University, New York City; David Magnus, Ph.D., associate professor of pediatrics and co-director, Stanford University Center for Biomedical Ethics; Jan. 25, 2006, Journal of the American Medical Association; Jan. 23, 2006, statement, Ken Johnson, senior vice president, Pharmaceutical Research and Manufacturers of America, Washington, D.C.
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