Healthy Skepticism Library item: 951

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Hensley S.
Follow The Money: Doctors, Drug Makers Too Cozy? New Guidelines Fuel the Debate
The Wall Street Journal 2005 Apr 5

Full text:

Keeping the interactions between doctors and drug makers wholesome is one subject of new ethics guidelines for internists, the doctors most adults see first for medical care. Yet this noble goal faces constant corrosion from financial temptation.

The American College of Physicians releases the fifth edition of its Ethics Manual in the current issue of the Annals of Internal Medicine. These guidelines strongly discourage doctors from accepting “gifts, hospitality, trips and subsidies of all types” from industry, such as pharmaceutical companies, cautioning physicians that small gifts have been shown to “affect clinical judgment” and heighten “the perception (as well as the reality) of a conflict of interest.” For the first time, the manual also directs professional societies, such as the ACP, that accept industry support to be on guard for potential bias or conflict from such support.

But are guidelines and good intentions up to the task? The drug industry’s substantial support of the ACP’s annual meeting raises concerns.

Later this month, the ACP will hold its annual meeting in San Francisco, a gathering expected to draw 7,000 physicians, 4,000 exhibitors, guests and other health-care providers. About half of the $4-million-plus budget for the meeting comes from the sale of exhibition space and sponsorships — companies can pay $60,000 to sponsor the meeting’s tote bags, $50,000 to sponsor the shuttle buses. Drug makers are the biggest spenders, as they are at many medical conferences, despite the large number of recruiters, publishers and educational institutions that rent modest booths.

The prospectus for exhibitors touts the meeting to pharmaceutical companies explicitly, saying it “stands out from all other meetings you attend because it offers an unparalleled opportunity to meet with physicians of power — prescribing power.”

John Mitas, executive vice president of the ACP, says the organization enforces a bright line separating the sponsorship from the content of the medical sessions that are the main purpose of the meeting. The ACP, he notes, has turned down groups judged incompatible with its mission, such as car makers eager to market their wares to well-heeled doctors.

Yet, the ACP has also turned down a request to exhibit from an organization that should be compatible with the mission of avoiding conflicts — No Free Lunch, a grassroots group that encourages health-care decision based on unbiased evidence rather than drug-industry promotion. On its Web site nofreelunch.org1, the group cheekily promotes an amnesty program for the logo-covered pens given to doctors, along with more serious information that can be used to teach medical students about hidden conflicts.

Robert Goodman, a New York internist who runs No Free Lunch in his spare time, called the ACP’s decision not to let it exhibit “disturbing and astounding” considering that it would prevent doctors from hearing an important educational message to balance out the promotional spiels elsewhere in the exhibit hall.

The ACP maintains that agitators from No Free Lunch caused trouble at its 2001 meeting, even sneaking in an undercover TV crew. Dr. Goodman says that even if there were some problems, which he isn’t sure is the case, that they weren’t orchestrated by the organization.

William Golden, chairman of the ACP’s Ethics and Human Rights Committee, says “the door is open for a better exchange of views.” The ACP also says Dr. Goodman is welcome to attend and participate in the meeting. “Our members are very sympathetic to the issue that Dr. Goodman advocates,” Dr. Golden explains. “But there’s a difference between exhibiting and activism.”

Some doctors look beyond the shortcomings in their relationship with the pharma industry. Prescription drugs remain among the most important tools for treating illness, so doctors have an understandable respect for the power of modern medicines. But while the recent controversy over the safety of prescription pain pills has further dented the already poor reputation of drug makers with consumers, many doctors remain sympathetic with the view that pharmaceuticals companies are on the right path. This, despite the shock from Merck & Co.‘s withdrawal of Vioxx last year and intensified worries earlier in 2004 about the role of antidepressants in suicide.

The divergent sentiment was captured in responses from doctors and patients on the question in recent surveys of whether the pharmaceutical industry is so flawed it needs to be overhauled. Almost twice as many consumers, or three-quarters of those polled, agreed strongly with that notion as compared with doctors, only 40% of whom said that was the case, according to surveys conducted in February by NOP World Health and Roper Public Affairs, both units of United Business Media PLC, a provider of business information services based in London.

Doctors blame journalists for exaggerating drug risks, with 81% agreeing completely or mostly with the statement that the media are overplaying the problems. Consumers, too, were mistrustful of media reports, though not quite as much as their doctors. Some 55% of consumers agreed completely or mostly with the notion that the media exaggerate drug-safety problems.

The results come from phone interviews of about 1,000 consumers and Internet questionnaires completed by 350 U.S. doctors, according to NOP World. The error margin for consumers was plus or minus three percentage points and plus or minus six percentage points for physicians. The polling wasn’t performed for a specific client, though NOP World hopes to sell the results to pharmaceutical companies.

The enduring bond between drug makers and the medical profession fuels a concern that the relationship remains too cozy. “There’s no way that drug safety is a problem primarily because the media is blowing it out of proportion,” says Paul Argenti, a professor of communications at Dartmouth College’s Tuck School of Business who reviewed the polling results. “All this tells me is that physicians are being influenced by drug companies even more than we thought.”

The spat between doctors wearing white coats may seem almost comical. But make no mistake, the soul of the medical profession and the primacy of doctors’ duty to their patients is under siege. For now, most consumers view the drug makers very skeptically — an opinion at odds with the one held by most doctors. The relationship of trust that most patients still seek with their doctors is at risk if physicians don’t take a closer look at their own relationship with the pharmaceutical industry.